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Preoperative Smoking Cessation is Integral to the Prevention of Postoperative Morbidities in Minimally Invasive Esophagectomy

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Abstract

Background

Preoperative smoking cessation is considered integral to decreasing postoperative morbidities after esophagectomy. To our knowledge, the association of the duration of smoking cessation with the occurrence of postoperative morbidity has never been investigated in minimally invasive esophagectomy (MIE).

Methods

A total of 198 consecutive MIEs for esophageal cancer between June 2011 and December 2017 were eligible for the study. According to the length of smoking cessation, patients were separated into three groups: ≤ 30, 31–90, and ≥ 91 days. Incidence of postoperative morbidities was retrospectively analyzed among the groups.

Results

In patients with smoking cessation ≤ 30 days, morbidities of Clavien–Dindo classification (CDc) ≥ II, severe morbidities of CDc ≥ IIIb, pneumonia, and any pulmonary morbidities were frequently observed. Morbidities of CDc ≥ II, pneumonia, and any pulmonary morbidities increased as the length of cessation became shorter. Smoking cessation ≤ 30 days was a significant risk factor for severe morbidity (hazard ratio [HR] 4.89, 95% confidence interval [CI] 1.993–12.011; P < 0.001). Smoking cessation ≤ 90 days (HR 3.98, 95% CI 1.442–10.971; P = 0.008), past smoking (per 100 increase in Brinkman index), and cardiovascular comorbidity were significant risk factors for pneumonia. Smoking cessation ≤ 30 days (HR 3.13, 95% CI 1.351–7.252; P = 0.008) and past smoking were significant risk factors for any pulmonary morbidity.

Conclusions

Preoperative smoking cessation is considerably important to prevent postoperative morbidities, even in MIE. At least, preoperative cessation ≥ 31 days is preferable to decrease considerable morbidities after MIE.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuoku, Kumamoto, 860-8556, Japan

    Naoya Yoshida, Kenichi Nakamura, Daisuke Kuroda, Yoshifumi Baba, Yuji Miyamoto, Masaaki Iwatsuki, Yukiharu Hiyoshi, Takatsugu Ishimoto & Hideo Baba

  2. Division of Translational Research and Advanced Treatment Against Gastrointestinal Cancer, Kumamoto University, 1-1-1 Honjo, Chuoku, Kumamoto, 860-8556, Japan

    Naoya Yoshida & Takatsugu Ishimoto

  3. Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Yu Imamura & Masayuki Watanabe

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  1. Naoya Yoshida
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  2. Kenichi Nakamura
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  4. Yoshifumi Baba
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Correspondence to Hideo Baba.

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Yoshida, N., Nakamura, K., Kuroda, D. et al. Preoperative Smoking Cessation is Integral to the Prevention of Postoperative Morbidities in Minimally Invasive Esophagectomy. World J Surg 42, 2902–2909 (2018). https://doi.org/10.1007/s00268-018-4572-3

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