To investigate the clinical outcome of laparoscopic and open total mesorectal excision in the treatment of patients combined with rectal cancer and COPD.

From January 2011 to December 2014, clinical data of 74 patients combined with rectal cancer and COPD were analyzed retrospectively, including 42 cases in laparoscopic group and 32 cases in laparotomy group. Statistical analysis were performed by using SPSS 19.0 software. Measurement data, such as intraoperative indicators, PIP and PaCO₂ were expressed as ±s, and were examined by using independent t test. Count data such as complications were examined by chi square test. A P value <0.05 was considered as statistically significant difference.

Compared with the laparotomy group, the laparoscopic group had higher peak airway pressure(21.8±1.7cmH and partial pressure of carbon dioxide (PaCO₂), the value of peak airway pressure(PIP) and partial pressure of carbon dioxide (PaCO₂) in the laparoscopic group were higher than those of the laparotomy group[(21.8±1.7) cmH₂O vs. (13.7±1.6) cmH₂O (t=21.093, P=0.000)]; [(52.8±4.4) mmHg vs. (35.6±3.2) mmHg (t=19.239, P=0.000)] respectively. Compared with the laparotomy group, laparoscopic group has less intraoperative bleeding volume (280±64 ml vs. 130±60 P<0.05). In terms of oxygen saturation after operation, postoperative anal exhaust time, indwelling catheter time, ambulation time and postoperative hospitalization time in the laparoscopic group were better than those in the laparotomy group (P<0.05). There was no significant difference of harvested lymph nodes between two groups (P>0.05). In addition, there were no significant difference of postoperative pulmonary complications between two groups, while the other complications in the laparoscopy group is less than those in laparotomy group.

To our knowledge, the pneumoperitoneum in laparoscopy for rectal cancer might have an adverse effect on the respiratory function of patients with COPD, however the minimal invasion could also be achieved in laparoscopic surgery, which could promote the recovery of postoperative pulmonary function, with better short-term clinical outcome. There are similar 2-year survival rate in both laparoscopic and laparotomy group.