Pulmonary function following laparoscopic or conventional colorectal resection -: A randomized controlled evaluation

Background: Laparotomy causes a significant reduction of pulmonary function, and atelectasis and pneumonia occur after elective conventional colorectal resections. Objective: To evaluate the hypothesis that pulmonary function is less restricted after laparoscopic than after conventional colorectal resection. Design: A randomized clinical trial. Setting: The surgical department of an academic medical center. Patients: Sixty patients underwent laparoscopic (n = 30) or conventional (n = 30) resection of colorectal tumors. The 2 groups did not differ significantly in age, sex, localization or stage of tumor, or preoperative pulmonary function. Main Outcome Measures: Forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow, mid-expiratory phase of forced expiratory flow, and oxygen saturation of arterial blood. Results: The forced vital capacity (mean +/- SD values: conventional resection group, 1.73 +/- 0.60 L; laparoscopic surgery group. 2.59 +/- 1.11 L; P<.01) and the forced expiratory volume in 1 second (conventional resection group, 1.19 +/- 0.51 L/s; laparoscopic surgery group, 1.80 +/- 0.80 L/s; P<.01) were more profoundly suppressed in the patients having conventional resection than in those having laparoscopic surgery. Similar results were found for the Peak expiratory flow (conventional resection group, 2.51 +/- 1.37 L/s; laparoscopic resection group, 3.60 +/- 2.22 L/s; P<.05) and the midexpiratory phase of forced expiratory) flow (conventional resection group, 1.87 +/- 1.12 L/s; laparoscopic surgery group, 2.67 +/- 1.76 L/s; P<.05). The oxygen saturation of arterial blood, measured while the patients were breathing room air, was lower after conventional than after laparoscopic resections (P<.01). The recover) of the forced vital capacity and forced expiratory volume in 1 second to 80% of the preoperative value took longer in patients having conventional resection than in those having laparoscopic resection (P<.01). Pneumonia developed in 2 patients having conventional resection, but no pulmonary infection occurred in the laparoscopic resection group (P>.05). Conclusions: Pulmonary function is better preserved after laparoscopic than after conventional colorectal resection. Pulmonary. complications may be reduced after Laparoscopic resections because of the better postoperative pulmonary function.