Smoking is a perioperative risk factor and prognostic factor for lung cancer surgery

Yamada

et al. 2019

ATCS

Purpose: Smoking is reported to be a risk factor for postoperative complications. However, there is no consensus regarding the length of time for which patients need to give up smoking. Therefore, we examined the relationship between preoperative smoking status and postoperative complications in patients who underwent lobectomy for treatment of lung cancer.Methods: Between January 2009 and December 2014, 1380 patients underwent lobectomy for lung cancer at our institution. After excluding patients who had undergone induction therapy, 1248 patients were enrolled in this study. We examined the relationship between postoperative complications and preoperative smoking habitation.Results: Among the enrolled patients, 1210 (97%) underwent video-assisted thoracoscopic lobectomy and 38 (3%) underwent lobectomy via open thoracotomy. The incidence of postoperative complications was higher in smokers than in nonsmokers, and the frequency of respiratory-related complications increased along with the number of pack-years. However, there was no relationship between the length of the preoperative smoking cessation period and the frequency of postoperative complications.Conclusion: The risk of postoperative complications does not increase even if smoking is continued within 2 weeks before surgery. It seems unnecessary to delay the timing of surgery to allow patients to cease smoking, especially those scheduled for thoracoscopic surgery.

Section: Discussionmentioning

confidence: 99%

Preoperative Smoking Cessation Period Is Not Related to Postoperative Respiratory Complications in Patients Undergoing Lung Cancer Surgery

Yamada

et al. 2019

ATCS

“…Rescheduling of the surgery is necessary to ensure safe postoperative management because lung cancer surgery itself is a risk factor for developing postoperative lung injury. 4 This rescheduling policy was also implemented in our study. Therefore, the withdrawal effect of nicotine for current smokers could have been weakened, so that no difference in postoperative pain outcomes was observed in our study.…”

Section: Discussionmentioning

confidence: 99%

“… 1 Thereby, the prevalence of smoking is high among patients diagnosed with lung cancer, 2 and following cancer surgery, smokers have worse outcomes than nonsmokers because of greater postoperative complications. 3 , 4 Moreover, since previous studies suggest that acute or chronic exposure to cigarette smoke affects acute and chronic painful conditions, 5 further caution needs to be exercised when providing perioperative care to patients with a smoking history and efficient strategies are needed for postoperative pain control. 6 …”

Section: Introductionmentioning

confidence: 99%

Relationship between pain outcomes and smoking history following video-assisted thoracic surgery for lobectomy: a retrospective study

Oh¹,

Kim²,

Jheon³

et al. 2018

JPR

PurposeThe relationship between chronic smoking history and postoperative pain remains controversial. This study aimed to elucidate this relationship in non-small cell lung cancer (NSCLC) patients who underwent video-assisted thoracic surgery (VATS) lobectomy.Patients and methodsThis retrospective observational study included NSCLC patients treated with VATS lobectomy between January 2011 and July 2017. Demographic and clinical information, including preoperative smoking history, was collected. The primary goal was to investigate the relationship between smoking history and postoperative pain outcomes (oral morphine equivalent [OME] consumption and pain score). Multivariate linear regression analysis was performed, and P<0.05 was considered as statistically significant.ResultsA total of 1,785 patients were included in the final analysis. Multivariate linear regression analysis revealed that total smoking amount (in packs), status as current smoker, and cessation time did not have an association with OME consumption (mg) or pain scores on postoperative days 0–2 (P>0.05). However, patients who had never smoked consumed less morphine equivalent analgesics (mg) on postoperative days 0–2 (coefficient: −17.48, 95% CI [−33.83, −1.13], P=0.036) compared to patients who had a history of smoking.ConclusionPatients who had never smoked had lower opioid analgesics consumption on the days immediately following surgery, while being a current smoker or the total amount of smoking in packs did not affect postoperative pain outcomes after VATS lung lobectomy.

Seminars in Radiation Oncology

“…Tobacco-induced immunosuppression could be another possible explanation for this effect [21, 22]. But these findings should in no way be taken to encourage patient smoking, because smoking is a risk factors for poorer survival [23, 24]. In fact, smokers often have limited pulmonary reserve, and are at a greater risk to develop respiratory failure even after a modest reduction of lung function.…”

Section: Smoking Statusmentioning

confidence: 99%

Nondosimetric Risk Factors for Radiation-Induced Lung Toxicity

Kong

Wang

2015

122

The decision to administer a radical course of radiotherapy is largely influenced by the dose-volume metrics of the treatment plan, but what are the patient related and other factors that may independently increase the risk of radiation lung toxicity? Poor pulmonary function has been regarded as a risk factor and relative contraindication for patients having radical radiotherapy, but recent evidence suggests that patients with poor spirometry may tolerate conventional or high dose radiotherapy as well as, if not better than, patients with normal function. However, caution may need to be exercised in patients with underlying interstitial pulmonary fibrosis. Further there is emerging evidence of molecular markers of increased risk of toxicity. This review will discuss patient related and risk factors other than dosimetry for radiation lung toxicity.