Effects of CO<sub>2</sub> Pneumoperitoneum and Posture on Circulation Function for Elderly Patients with Rectal Cancer During Laparoscopic Operation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YANGSun-hu ^1,2 , HOUJun-li ² , ABUDUSIMU ² ,  TABUSI Ahetibieke ² , ZHENGJian-zhong ² , MABo ² , RENFei ²

1. Department of General Surgery, No.3 People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 201900, China;
2. Depar-tment of General Surgery, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi 830063, Xiniang Uygur Autonomous Region, China;

Corresponding author：

TABUSI Ahetibieke, Email: ahet050@sina.com

Keywords：

Elderly patient; Rectal cancer; Laparoscopic operation; Circulation function

DOI：

10.7507/1007-9424.20150088

Video：

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Objective To explore the effects of CO₂ pneumoperitoneum and posture on circulation function for elderly patients with rectal cancer during laparoscopic operation. Methods Retrospective analysis of clinical data of 48 elderly patients with rectal cancer was performed, and the data included the heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), cardiac output (CO), cardiac index (CI), central venous pressure (CVP), pH, partial pressure of oxygen (PaO₂), and partial pressure of carbon dioxide (PaCO₂) at before anesthesia (T₁), after anesthesia (T₂), after the establishment of CO₂ pneumoperitoneum (T₃), placement in trendelenburg position after operation (T₄), 30 minutes after operation (T₅), 60 minutes after operation (T₆), 90 minutes after operation (T₇), and 120 minutes after operation (T₈). Results The levels of HR, SBP, DBP, MAP, CO, CI, pH, PaO₂, and PaCO₂ at 8 time points didn't statistically differed with each other (P>0.05), but the levels of CVP at T7 and T8 time point were significantly higher than those of T1 and T2 time point (P<0.05). Conclusions During laparoscopic operation period for the elderly patients with rectal cancer, the CVP will gradually increase. If the preoperative assessment and administration are done well during peri-operation period, laparoscopic operation is safe for the elderly patients with rectal cancer.

Citation： YANGSun-hu, HOUJun-li, ABUDUSIMU, TABUSI Ahetibieke, ZHENGJian-zhong, MABo, RENFei. Effects of CO₂ Pneumoperitoneum and Posture on Circulation Function for Elderly Patients with Rectal Cancer During Laparoscopic Operation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(3): 331-334. doi: 10.7507/1007-9424.20150088 Copy

1.	Guillou PJ, Quirke P, Thorpe H, 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(9472):1718-1726.
2.	Veldkamp R, Kuhry E, Hop WC, et al. Laparoscopic surgery versus open surgery for colon cancer:short-term outcomes of a randomised trial. Lancet Oncol, 2005, 6(7):477-484.
3.	Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoseopically assisted and open colectomy for colon cancer. N Engl J Med, 2004, 350(20):2050-2059.
4.	Fleshman J, Sargent DJ, Green E, et al. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg, 2007, 246(4):655-662.
5.	Colon Cancer Laparoscopic or Open Resection Study Group; Buunen M, Veldkamp R, et al. Survival after laparoscopic surgery versus open surgery for colon cancer:long-term outcome of a randomised clinical trial. Lancet Oncol, 2009, 10(1):44-52.
6.	Jayne DG, Thorpe HC, Copeland J, et al. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg, 2010, 97(11):1638-1645.
7.	Roscio F, Bertoglio C, De Luca A, et al. Outcomes of laparoscopic surgery for colorectal cancer in elderly patients. JSLS, 2011, 15(3):315-321.
8.	王金保, 王姝媛, 王琪, 等. 不同气腹压条件下腹腔镜胆囊摘除术患者血流动力学的变化. 临床麻醉学杂志, 2012, 28(2):163-165.
9.	Jacobs M, Verdeja JC, Goldstein HS. Laparoscopic choledocholitho-tomy. J Laparoendosc Surg, 1991, 1(2):79-82.
10.	范莹, 吴硕东, 于宏, 等. 腹腔镜结直肠癌根治术与同期开腹手术对比的单中心回顾性研究. 中国普外基础与临床杂志, 2009, 16(5):384-388.
11.	梁耀泽, 余江, 张策, 等. 腹腔镜与同期开腹直肠癌根治术后肿瘤学结果对比研究. 中国普外基础与临床杂志, 2010, 17(6):591-595.
12.	周海涛, 周志祥. 腹腔镜手术或将成为高龄结直肠癌患者的常规外科治疗方法. 中华肿瘤杂志, 2014, 36(1):2-4.
13.	卞正乾, 钟鸣, 唐伟军, 等. 80岁以上高龄结直肠癌患者接受腹腔镜辅助根治手术的围手术期安全性观察. 腹腔镜外科杂志, 2009, 14(1):41-44.
14.	孙建萍, 伍冀湘, 张京岚. 开腹、气腹腹腔镜、无气腹腹腔镜结直肠癌手术对高龄患者术中心肺功能的影响. 中国微创外科杂志, 2010, 10(9):826-829.
15.	Kanwer DB, Kaman L, Nedounsejiane M, et al. Comparative study of low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy-a randomised controlled trial. Trop Gastroenterol, 2009, 30(3):171-174.
16.	Russo A, Marana E, Viviani D, et al. Diastolic function:the influence of pneumoperitoneum and Trendelenburg positioning during laparoscopic hysterectomy. Eur J Anaesthesiol, 2009, 26(11):923-927.
17.	Falabella A, Moore-Jeffries E, Sullivan MJ, et al. Cardiac function during steep Trendelenburg position and CO₂ pneumoperitoneum for robotic-assisted prostatectomy:a trans-oesophageal Doppler probe study. Int J Med Robot, 2007, 3(4):312-315.
18.	Alves A, Panis Y, Mathieu P, et al. Postoperative mortality and morbidity in French patients undergoing colorectal surgery:results of a prospective multicenter study. Arch Surg, 2005, 140(3):278-284.
19.	Alves A, Panis Y, Mantion G, et al. The AFC score:validation of a 4-item predicting score of postoperative mortality after colorectal resection for cancer or diverticulitis:results of a prospective multicenter study in 1 049 patients. Ann Surg, 2007, 246(1):91-96.
20.	Person B, Cera SM, Sands DR, et al. Do elderly patients benefit from laparoscopic colorectal surgery?. Surg Endos, 2008, 22(2):401-405.
21.	Latkauskas T, Rudinskaite G, Kurtinaitis J, et al. The impact of age on post-operative outcomes of colorectal cancer patients undergoing surgical treatment. BMC Cancer, 2005, 5:153.
22.	Grailey K, Markar SR, Karthikesalingam A, et al. Laparoscopic versus open colorectal resection in the elderly population. Surg Endosc, 2013, 27(1):19-30.
23.	梁辉, 管蔚, 陈国玉. 不同年龄直肠癌患者行腹腔镜与行开腹根治术的比较. 中国普外基础与临床杂志, 2009, 16(10):789-792.
24.	Pinto RA, Ruiz D, Edden Y, et al. How reliable is laparoscopic colorectal surgery compared with laparotomy for octogenarians?. Surg Endosc, 2011, 25(8):2692-2698.

1. Guillou PJ, Quirke P, Thorpe H, 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(9472):1718-1726.
2. Veldkamp R, Kuhry E, Hop WC, et al. Laparoscopic surgery versus open surgery for colon cancer:short-term outcomes of a randomised trial. Lancet Oncol, 2005, 6(7):477-484.
3. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoseopically assisted and open colectomy for colon cancer. N Engl J Med, 2004, 350(20):2050-2059.
4. Fleshman J, Sargent DJ, Green E, et al. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg, 2007, 246(4):655-662.
5. Colon Cancer Laparoscopic or Open Resection Study Group; Buunen M, Veldkamp R, et al. Survival after laparoscopic surgery versus open surgery for colon cancer:long-term outcome of a randomised clinical trial. Lancet Oncol, 2009, 10(1):44-52.
6. Jayne DG, Thorpe HC, Copeland J, et al. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg, 2010, 97(11):1638-1645.
7. Roscio F, Bertoglio C, De Luca A, et al. Outcomes of laparoscopic surgery for colorectal cancer in elderly patients. JSLS, 2011, 15(3):315-321.
8. 王金保, 王姝媛, 王琪, 等. 不同气腹压条件下腹腔镜胆囊摘除术患者血流动力学的变化. 临床麻醉学杂志, 2012, 28(2):163-165.
9. Jacobs M, Verdeja JC, Goldstein HS. Laparoscopic choledocholitho-tomy. J Laparoendosc Surg, 1991, 1(2):79-82.
10. 范莹, 吴硕东, 于宏, 等. 腹腔镜结直肠癌根治术与同期开腹手术对比的单中心回顾性研究. 中国普外基础与临床杂志, 2009, 16(5):384-388.
11. 梁耀泽, 余江, 张策, 等. 腹腔镜与同期开腹直肠癌根治术后肿瘤学结果对比研究. 中国普外基础与临床杂志, 2010, 17(6):591-595.
12. 周海涛, 周志祥. 腹腔镜手术或将成为高龄结直肠癌患者的常规外科治疗方法. 中华肿瘤杂志, 2014, 36(1):2-4.
13. 卞正乾, 钟鸣, 唐伟军, 等. 80岁以上高龄结直肠癌患者接受腹腔镜辅助根治手术的围手术期安全性观察. 腹腔镜外科杂志, 2009, 14(1):41-44.
14. 孙建萍, 伍冀湘, 张京岚. 开腹、气腹腹腔镜、无气腹腹腔镜结直肠癌手术对高龄患者术中心肺功能的影响. 中国微创外科杂志, 2010, 10(9):826-829.
15. Kanwer DB, Kaman L, Nedounsejiane M, et al. Comparative study of low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy-a randomised controlled trial. Trop Gastroenterol, 2009, 30(3):171-174.
16. Russo A, Marana E, Viviani D, et al. Diastolic function:the influence of pneumoperitoneum and Trendelenburg positioning during laparoscopic hysterectomy. Eur J Anaesthesiol, 2009, 26(11):923-927.
17. Falabella A, Moore-Jeffries E, Sullivan MJ, et al. Cardiac function during steep Trendelenburg position and CO₂ pneumoperitoneum for robotic-assisted prostatectomy:a trans-oesophageal Doppler probe study. Int J Med Robot, 2007, 3(4):312-315.
18. Alves A, Panis Y, Mathieu P, et al. Postoperative mortality and morbidity in French patients undergoing colorectal surgery:results of a prospective multicenter study. Arch Surg, 2005, 140(3):278-284.
19. Alves A, Panis Y, Mantion G, et al. The AFC score:validation of a 4-item predicting score of postoperative mortality after colorectal resection for cancer or diverticulitis:results of a prospective multicenter study in 1 049 patients. Ann Surg, 2007, 246(1):91-96.
20. Person B, Cera SM, Sands DR, et al. Do elderly patients benefit from laparoscopic colorectal surgery?. Surg Endos, 2008, 22(2):401-405.
21. Latkauskas T, Rudinskaite G, Kurtinaitis J, et al. The impact of age on post-operative outcomes of colorectal cancer patients undergoing surgical treatment. BMC Cancer, 2005, 5:153.
22. Grailey K, Markar SR, Karthikesalingam A, et al. Laparoscopic versus open colorectal resection in the elderly population. Surg Endosc, 2013, 27(1):19-30.
23. 梁辉, 管蔚, 陈国玉. 不同年龄直肠癌患者行腹腔镜与行开腹根治术的比较. 中国普外基础与临床杂志, 2009, 16(10):789-792.
24. Pinto RA, Ruiz D, Edden Y, et al. How reliable is laparoscopic colorectal surgery compared with laparotomy for octogenarians?. Surg Endosc, 2011, 25(8):2692-2698.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effects of CO₂ Pneumoperitoneum and Posture on Circulation Function for Elderly Patients with Rectal Cancer During Laparoscopic Operation

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effects of CO2 Pneumoperitoneum and Posture on Circulation Function for Elderly Patients with Rectal Cancer During Laparoscopic Operation

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Effects of CO₂ Pneumoperitoneum and Posture on Circulation Function for Elderly Patients with Rectal Cancer During Laparoscopic Operation