Importance of Smoking Cessation on Surgical Outcome in Primary Lung Cancer

Background. 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. Methods. A retrospective study was conducted on patients with stage I to III primary lung cancer who underwent resection between 2012 and 2016. The rate of operative 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. Results. This study included 666 patients, of whom 256 (38.4%) were never smokers and 410 (61.6%) were smokers. Significant differences were found between the smokers and never smokers regarding the 90-day mortality rate (2.0% versus 0%, p = 0.025) and respiratory complications (22.3% versus 3.5%, p < 0.001). A multivariate analysis indicated that smoking (odds ratio [OR] 2.8, p = 0.017), forced expiratory volume in 1 second/forced vital capacity less than 0.7 (OR 2.6, p = 0.001), percentage of diffusing capacity of the lung for carbon monoxide less than 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 with never smokers, the ORs for pulmonary complications at each cessation interval (current smoker/cessation for <1month, 1 to 3 months, 3 to 6 months, 6 to 12 months, and >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), and 5.0 (p < 0.001), respectively. Conclusions. A longer period of cessation might be more effective for reducing the risk of pulmonary complications. Smoking cessation at any time is valuable for lung cancer surgery. (C) 2019 by The Society of Thoracic Surgeons