Smoking Cessation Before Surgery Shows Reduced Benefit

Patients who quit smoking within a month of surgery to treat lung cancer had more complications than those with a longer time off tobacco and those who had never smoked, according a new study.

Researchers at Roswell Park Cancer Center (Buffalo, NY, USA) conducted a study involving 706 patients who underwent thoracoscopic lobectomy for lung cancer. Patients smoking status was divided into five groups: never smokers; over 12 month’s cessation; 1–12 month’s cessation; 0.5–1 month’s preoperative cessation; and current smokers. Odds ratios for different postoperative outcomes amongst the five groups were adjusted for age, chronic obstructive pulmonary disease (COPD), chemotherapy, respiratory measures, and intraoperative blood transfusion.

The results showed that current smokers and recent quitters had a significantly lower age (median 62 years), higher incidence of COPD (49%), and lower preoperative forced expiratory volume (FEV1) and diffusing capacity of the lungs for carbon monoxide (DLCO). Compared to never-smokers, the recent quitters had significantly higher odds for postoperative pulmonary complications, in-hospital stay longer than three days, and postoperative packed red blood cells (PRBC) transfusion. The study was presented at the annual CHEST meeting, held during October 2015 in Montréal (Canada).

“For thoracoscopic lobectomy, brief smoking cessation of 30 days or less provides no immediate advantage, and may actually increase complications. Long cessation intervals reduce pulmonary complications and hospital stays significantly compared to continued smoking status,” concluded lead author and study presenter Elisabeth Dexter, MD, and colleagues. “Proactive initiation of smoking cessation counseling at first patient contact is essential, and delay of surgery until 30 days after smoking cessation should be considered.”

Lung cancer claims a global toll of 3,000 lives each day, largely as a result of cigarette smoking, which has also been linked to at least 18 other types of cancer. The harmful substances present in tobacco smoke, collectively known as polycyclic aromatic hydrocarbons (PAHs), are one of the major culprits in causing lung cancer.

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Roswell Park Cancer Center