Skip to main content

Advertisement

SpringerLink
Log in

Impact of intraoperative hypocapnia on postoperative complications in laparoscopic surgery for colorectal cancer

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

In laparoscopic surgery (LS) for colorectal cancer (CRC), the relationship between intraoperative end-tidal carbon dioxide concentration (EtCO2) and surgery-related complications remains unexplored. This study assessed the impact of intraoperative EtCO2 on postoperative complications in LS for CRC.

Methods

In total, 909 patients who underwent LS for CRC were enrolled. Hypocapnia and hypercapnia were defined as EtCO2 < 35 mmHg and > 40 mmHg, respectively, and the relationships between hypocapnia or hypercapnia duration and postoperative complications were analyzed.

Results

The median (range) durations of hypocapnia and hypercapnia were 2.0 (0–8.3) h and 0.3 (0–5.8) h, respectively. Complications were observed in 208 cases (23.0%), which included 37 (4.1%) instances of anastomotic leakage and 86 (9.5%) of superficial surgical site infection (SSI). While the hypercapnia duration was not associated with the short-term outcomes, prolonged hypocapnia was significantly correlated with complications (p = 0.02), specifically superficial SSI (p = 0.005). Multivariate analyses adjusted for confounding factors confirmed that hypocapnia prolongation was an independent risk factor for postoperative superficial SSI [OR 1.19; 95% confidence interval (Cl) 1.03–1.36, p = 0.01].

Conclusion

Intraoperative hypocapnia may be a risk factor for postoperative complications, in particular superficial SSI, in LS for CRC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2020;68:394–424.

    Article  Google Scholar 

  2. Green BL, Marshall HC, Collinson F, Quirke P, Guillou P, Jayne DG, et al. Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg. 2013;100:75–82.

    Article  CAS  Google Scholar 

  3. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365:1718–26.

    Article  Google Scholar 

  4. Pishbin E, Ahmadi GD, Sharifi MD, Deloei MT, Shamloo AS, Reihani H. The correlation between end-tidal carbon dioxide and arterial blood gas parameters in patients evaluated for metabolic acid-base disorders. Electron Physician. 2015;7:1095–101.

    PubMed  PubMed Central  Google Scholar 

  5. Dony P, Dramaix M, Boogaerts JG. Hypocapnia measured by end-tidal carbon dioxide tension during anesthesia is associated with increased 30-day mortality rate. J Clin Anesth. 2017;36:123–6.

    Article  Google Scholar 

  6. Fujimoto D, Egi M, Makino S, Mizobuchi S. The association of intraoperative end-tidal carbon dioxide with the risk of postoperative nausea and vomiting. J Anesth. 2020;34:195–201.

    Article  Google Scholar 

  7. Berriós-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152:784–91.

    Article  Google Scholar 

  8. Way M, Hill GE. Intraoperative end-tidal carbon dioxide concentrations: what is the target? Anesthesiol Res Pract. 2011;2011:10–3.

    Google Scholar 

  9. Wax DB, Lin HM, Hossain S, Porter SB. Intraoperative carbon dioxide management and outcomes. Eur J Anaesthesiol. 2010;27:819–23.

    Article  Google Scholar 

  10. Park EY, Kwon JY, Kim KJ. Carbon dioxide embolism during laparoscopic surgery. Yonsei Med J. 2012;53:459–66.

    Article  Google Scholar 

  11. Gutt CN, Oniu T, Mehrabi A, Schemmer P, Kashfi A, Kraus T, et al. Circulatory and respiratory complications of carbon dioxide insufflation. Dig Surg. 2004;21:95–105.

    Article  CAS  Google Scholar 

  12. Bonjer HJ, Hazebroek EJ, Kazemier G, Giuffrida MC, Meijer WS, Lange JF. Open versus closed establishment of pneumoperitoneum in laparoscopic surgery. Br J Surg. 1997;84:599–602.

    CAS  PubMed  Google Scholar 

  13. Mm A. Risks and prophylaxis in laparoscopy: 100,000 cases. J Reprod Med. 1977;18:269–72.

    Google Scholar 

  14. Pinsky MR. Cardiovascular effects of ventilatory support. Anesth Anal. 1994;79:567–76.

    Article  CAS  Google Scholar 

  15. Laffey JG, Kavanagh BP. Hypocapnia. N Engl J Med. 2002;347:43–53.

    Article  CAS  Google Scholar 

  16. Mutch WAC, El-Gabalawy R, Girling L, Kilborn K, Jacobsohn E, Popa-Wagner A, et al. End-tidal hypocapnia under anesthesia predicts postoperative delirium. Front Neurol. 2018;1:678.

    Article  Google Scholar 

  17. Golparvar M, Saghaei M, Matin G. Effects of intra-operative end-tidal carbon dioxide levels on the rates of postoperative complications in adults undergoing general anesthesia for percutaneous nephrolithotomy: a clinical trial. Adv Biomed Res. 2014;3:84.

    Article  Google Scholar 

  18. Gottrup F, Sci DM. Oxygen in wound healing and infection. J Surg. 2004;28:312–5.

    Google Scholar 

  19. Kurz A, Kopyeva T, Suliman I, Podolyak A, You J, Lewis B, et al. Supplemental oxygen and surgical-site infections: an alternating intervention controlled trial. Br J Anaesth. 2018;120:117–26.

    Article  CAS  Google Scholar 

  20. Greif R, Akça O, Horn EP, Kurz A, Sessler DI. Supplemental perioperative oxygen to reduce the incidence of surgical- wound infection. N Engl J Med. 2000;342:161–7.

    Article  CAS  Google Scholar 

  21. Melling AC, Ali B, Scott EM, Leaper DJ. Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial. Lancet. 2001;358:876–80.

    Article  CAS  Google Scholar 

  22. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med. 1996;334:1209–15.

    Article  CAS  Google Scholar 

  23. Guzman JA, Kruse JA. Splanchnic hemodynamics and gut mucosal-arterial PCO2 gradient during systemic hypocapnia. J Appl Physiol. 1999;87:1102–6.

    Article  CAS  Google Scholar 

  24. Guzman JA, Kruse JA. Gut mucosal-arterial PCO2 gradient as an indicator of splanchnic perfusion during systemic hypo- and hypercapnia. Crit Care Med. 1999;27:2760–5.

    Article  CAS  Google Scholar 

  25. Buggy D. Can anaesthetic management influence surgical-wound healing? Lancet. 2000;356:355–7.

    Article  CAS  Google Scholar 

  26. Korol E, Johnston K, Waser N, Sifakis F, Jafri HS. A systematic review of risk factors associated with surgical site infections among surgical patients. PLoS ONE. 2013;8:83743.

    Article  Google Scholar 

  27. Marchi M, Pan A, Gagliotti C, Morsillo F, Parenti M, Resi D, et al. The Italian national surgical site infection surveillance programme and its positive impact, 2009 to 2011. Eurosurveillance. 2014;19:1.

    Article  Google Scholar 

Download references

Acknowledgements

S. Morita and M. Tsuruta contributed equally to all aspects of this study, including the study design and coordination as well as manuscript preparation. K. Okabayashi, T. Ishida, K. Shigeta, R. Seishima and A. N. Skelly contributed to the design of the study and performed the statistical analyses. O. Itano, H. Hasegawa, and Y. Kitagawa conceived the study, participated in its design and coordination, and helped draft the manuscript.

Author information

Authors and Affiliations

  1. Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan

    Satoru Morita, Masashi Tsuruta, Koji Okabayashi, Kohei Shigeta, Ryo Seishima & Yuko Kitagawa

  2. Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare Narita Hospital, Chiba, Japan

    Masashi Tsuruta, Takashi Ishida & Osamu Itano

  3. Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan

    Hirotoshi Hasegawa

Authors
  1. Satoru Morita
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masashi Tsuruta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Koji Okabayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takashi Ishida
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kohei Shigeta
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ryo Seishima
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Osamu Itano
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hirotoshi Hasegawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yuko Kitagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masashi Tsuruta.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Morita, S., Tsuruta, M., Okabayashi, K. et al. Impact of intraoperative hypocapnia on postoperative complications in laparoscopic surgery for colorectal cancer. Surg Today 52, 278–286 (2022). https://doi.org/10.1007/s00595-021-02315-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-021-02315-4

Keywords

Search

Navigation