Postoperative pulmonary complications (PPCs) occur in over 33% of patients after laparoscopic gastrointestinal cancer surgery, but modifiable factors can help reduce risk.

• Identified independent risk factors include upper abdominal surgery (OR 5.609), higher smoking intensity (OR 1.025), and minilaparotomy-assisted plateau pressure above 16 cmH₂O (OR 1.574).
• Maintaining plateau pressure between 12-14 cmH₂O significantly lowers the risk of PPCs.

Surgeons should focus on optimizing respiratory management and closely monitor postoperative oxygen saturation to mitigate PPC risks.