Original article
General thoracic
Impact of Smoking Cessation Before Resection of Lung Cancer: A Society of Thoracic Surgeons General Thoracic Surgery Database Study

Presented at the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.
https://doi.org/10.1016/j.athoracsur.2009.04.035Get rights and content

Background

Smoking cessation is presumed to be beneficial before resection of lung cancer. The effect of smoking cessation on outcome was investigated.

Methods

From January 1999 to July 2007, in-hospital outcomes for 7990 primary resections for lung cancer in adults were reported to the Society of Thoracic Surgeons General Thoracic Surgery Database. Risk of hospital death and respiratory complications was assessed according to timing of smoking cessation, adjusted for clinical confounders.

Results

Hospital mortality was 1.4% (n = 109), but 1.5% in patients who had smoked (105 of 6965) vs 0.39% in those who had not (4 of 1025). Compared with the latter, risk-adjusted odds ratios were 3.5 (p = 0.03), 4.6 (p = 0.03), 2.6 (p = 0.7), and 2.5 (p = 0.11) for those whose timing of smoking cessation was categorized as current smoker, quit from 14 days to 1 month, 1 to 12 months, or more than 12 months preoperatively, respectively. Prevalence of major pulmonary complications was 5.7% (456 of 7965) overall, but 6.2% in patients who had smoked (429 of 6941) vs 2.5%% in those who had not (27 of 1024). Compared with the latter, risk-adjusted odds ratios were 1.80 (p = 0.03), 1.62 (p = 0.14), 1.51 (p = 0.20), and 1.29 (p = 0.3) for those whose timing of smoking cessation was categorized as above.

Conclusions

Risks of hospital death and pulmonary complications after lung cancer resection were increased by smoking and mitigated slowly by preoperative cessation. No optimal interval of smoking cessation was identifiable. Patients should be counseled to stop smoking irrespective of surgical timing.

Section snippets

Data Source

The STS established the ongoing prospective General Thoracic Surgery Database on January 1, 1999. Data are submitted voluntarily for quality monitoring by multiple hospitals, group practices, and surgeons throughout the United States, which for this study included 79 centers. Each center or surgeon completes a standardized form that is keyed into certified software and harvested annually for submission to the Duke Clinical Research Institute, which is charged with maintaining and analyzing

Hospital Mortality

Although overall hospital mortality was low at 1.4% (109 of 7990), it was 1.5% among current or past smokers (105 of 6965) compared with 0.3% among patients who had never smoked (4 of 1025, Table 2). Mortality was lower among patients with longer intervals of smoking cessation before resection (Table 3,Fig 2); however, no sharp transition to low risk was identified. Cause of death was not available in the STS database.

Pulmonary Complications

Major pulmonary complications were infrequent (5.7% of patients; 456 of

Comment

Most patients undergoing pulmonary resection for bronchogenic carcinoma have some smoking history, and many are active smokers [3]; however, the optimal timing of smoking cessation before pulmonary resection remains uncertain. In delaying the operation, thoracic surgeons must balance the risk of local tumor growth (tumor doubling) [7], risk of metastasis, and patient anxiety [8] against the benefit of reduced operative risk [9]. This clinical dilemma arises frequently: Almost 30% of patients in

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