The Importance of Smoking Cessation on Surgical Outcome in Primary Lung Cancer

Fukui M, Suzuki K, Matsunaga T, Oh S, Takamochi K. Ann Thorac Surg. 2019 Jan 2. pii: S0003-4975(18)31871-X. [CrossRef] [PubMed] 

Smoking cessation is important in the management of patients who require pulmonary resection. However, the impact of short-term smoking cessation on the surgical outcome remains unclear. The authors conducted a retrospective study was conducted on patients with stage I-III primary lung cancer who underwent resection between 2012 and 2016. The rate of surgical mortality and morbidity were evaluated according to smoking status. The relationship between the preoperative interval of smoking cessation and pulmonary complications after surgery was also examined. The study included 666 patients, of which 256 (38.4%) were never smokers and 410 (61.6%) were smokers. There were significant differences between the smokers and never smokers regarding the 90-day mortality rate (2.0% vs 0%, p=0.025), and respiratory complications (22.3% vs 3.5%, p<0.001). A multivariate analysis indicated that smoking (OR 2.8, p = 0.017), FEV 1.0/ FVC < 0.7 (OR 2.6, p = 0.001), %DLCO < 40% (OR 4.2, p =<0.001), and clinical stage of lung cancer (OR 2.3, p = 0.005) were predictors of pulmonary complications after pulmonary resection. In comparison to never smokers, the odds ratios for pulmonary complications at each cessation interval (Current smoker/ cessation for -1month/ 1-3 months/ 3-6 months/ 6-12 months/ > 12 months) were 12.9 (p < 0.001)/ 10.3 (p < 0.001)/ 8.5 (p < 0.001)/ 6.3 (p=0.011)/ 6.0 (p = 0.003)/ 5.0 (p < 0.001). A longer period of cessation might be more effective for reducing the risk of pulmonary complications, however, even short-term smoking cessation is beneficial prior to thoracotomy for lung cancer.