EPD401 - Potential Benefits of Low-Pressure Pneumoperitoneum on Early Postoperative Quality of Life After Minimally Invasive Colorectal Cancer Surgery

Purpose/Background: By reducing intra-abdominal pressure, low-pressure pneumoperitoneum may mitigate cardiopulmonary burden, lessen postoperative pain, and accelerate the return of bowel function. However, its influence on patient-reported quality of life within an enhanced recovery after surgery (ERAS) framework has not been well defined. We sought to determine whether a low-pressure pneumoperitoneum translates into measurable improvements in early postoperative quality of life compared with conventional-pressure pneumoperitoneum in minimally invasive colorectal cancer surgery.

Methods/Interventions: Prospectively collected data from the institutional ERAS registry were analyzed. Adult patients who underwent elective minimally invasive radical resection for colorectal cancer between January 2024 and September 2025 were included. Patients were stratified by intra-abdominal pressure: low pressure (8 mmHg) maintained with the AirSeal® iFS system and standard pressure (12 mmHg). Postoperative pain and quality of life were assessed using the 11-point numerical rating scale (NRS), EQ-VAS (visual analogue scale), and EQ-5D-5L index from postoperative day (POD) 1 to 5. Between-group comparisons were performed with linear mixed-effects models, and multivariable linear regression was used to adjust for baseline clinical and operative characteristics.

Results/Outcomes: A total of 125 patients were included, of whom 66 (52.8%) underwent surgery under low-pressure pneumoperitoneum. Baseline demographics, surgical approach, and procedure types were well balanced between groups. Across POD 1-5, linear mixed modeling demonstrated significant temporal improvements in pain and quality-of-life metrics (all p < 0.001) in both groups. NRS pain scores, both at rest and during movement, decreased over time with no between-group difference. Whereas EQ-VAS scores improved similarly in both cohorts (p = 0.213), the EQ-5D-5L index remained higher in the low-pressure group (β = 0.086, p = 0.004). On POD 1, the EQ-5D-5L index was significantly higher in the low-pressure group (0.56 [0.38-0.72] vs 0.42 [0.33-0.56]; p = 0.022); the difference narrowed with time (interaction p = 0.051). In multivariable analysis, the adjusted between-group difference in EQ-5D-5L index on POD 1 was 0.07 (95% CI, −0.009 to 0.150; p = 0.082). The median postoperative stay was shorter in the low-pressure group (5.0 [5-6] days) than in the standard-pressure group (6.0 [5-9] days; p = 0.002).

Conclusion/Discussion: Compared with standard-pressure pneumoperitoneum, low-pressure pneumoperitoneum appeared to be associated with better early postoperative quality of life and a shorter hospital stay, without compromising safety. Although postoperative pain trajectories were comparable, the low-pressure approach showed a tendency toward earlier gains in health-related quality of life, reflected by higher EQ-5D-5L scores during the initial postoperative period. These findings suggest that maintaining a stable low-pressure pneumoperitoneum may strengthen key ERAS principles-facilitating early functional recovery and improving patient-reported outcomes-without increasing surgical risk.

Fig. 1. Comparison of EQ-5D-5L index between low-pressure pneumoperitoneum with AirSeal and standard-pressure pneumoperitoneum.