Low pneumoperitoneum pressure on venous thromboembolism in laparoscopic colorectal cancer surgery: A randomized controlled study

• DOI: 10.1016/j.ejso.2024.108672
• Publication Date: 2024-09-06T14:21:12Z
• Authors: Lian Xia; Xin Xu; Chimin Zhang; Gaoyang Cao; Li Chen; Engeng Chen; Wei Zhang; Haiou Qi; Wei Zhou
• Keywords: Male; Incidence; Operative Time; Blood Loss, Surgical; Venous Thromboembolism; Middle Aged; Fibrin Fibrinogen Degradation Products; Postoperative Complications; Double-Blind Method; Robotic Surgical Procedures; Pressure; Humans; Female; Laparoscopy; Colorectal Neoplasms; Pneumoperitoneum, Artificial; Aged

Venous thromboembolism (VTE) poses a significant risk in colorectal cancer surgeries due to hypercoagulability and the anatomical challenges of the pelvic cavity. With the advancement of minimally invasive techniques, intraoperative strategies for preventing VTE may prove to be effective. This study explores the effects of intraoperative pneumoperitoneum pressures on VTE incidence following colorectal cancer surgeries.This single center parallel randomized controlled double-blind, trial involved 302 patients undergoing elective laparoscopic or robotic colorectal surgery. Patients were randomized to either a standard pneumoperitoneum pressure group (SP: 15 mmHg) or a low-pressure group (LP: 10 mmHg). Primary outcomes measured were the incidence of VTE, including symptomatic and asymptomatic DVT and PE. Secondary outcomes included postoperative D-dimer levels, surgery duration, blood loss, surgeon satisfaction, and oncological quality.Out of 302 randomized patients, 275 were evaluable post exclusions, with 138 in the SP group and 137 in the LP group. The incidence of VTE was 10.9 % in the SP and 13.9 % in the LP group, with no significant difference between the two (P = 0.450). Secondary outcomes such as D-dimer levels, surgery duration, and blood loss showed no significant differences between two groups. Surgeon satisfaction and oncological outcomes were similarly comparable.The trial demonstrated no significant difference in the incidence of VTE between standard and low pneumoperitoneum pressures. This suggests that lower pressures may not necessarily provide a benefit in reducing postoperative VTE in colorectal cancer surgeries.