Lung cancer is the second most common cancer in the United States and is the leading cause of cancer mortality, accounting for 25% of all cancer deaths.1 The most common type of lung cancer is non–small-cell lung cancer (NSCLC), comprising 85% of all lung cancer cases.1 Early cases of NSCLC are treated with surgery that may have a curative effect.2 People who smoke have a much higher risk of developing lung cancer than nonsmokers, with smoking contributing to approximately 85% of NSCLC cases.1 In addition to being a risk factor for developing NSCLC, smoking also contributes to other adverse long-term outcomes, including the development of other primary cancers, all-cause mortality, and postoperative adverse events. As smoking is a modifiable risk factor, all patients with lung cancer are advised to quit smoking immediately through behavioral modifications and pharmacotherapy.
Preoperative smoking cessation is associated with fewer complications, but the available studies present conflicting evidence on how long of an interval between smoking cessation and surgery is ideal. To determine the association between duration of preoperative smoking cessation and short-term (30-day) postoperative complications and mortality, a retrospective cohort study of 9509 adult patients with clinical stage I NSCLC who underwent surgery between 2006 and 2016 at the Veterans Health Administration was performed. Patients aged <18 years, those who had never smoked, those having surgery for recurrent disease, and those who received neoadjuvant chemotherapy were excluded from the study.
Major complications were defined as stroke, pneumonia, renal failure, empyema, myocardial infarction, or respiratory failure. The study included 6168 patients who were smokers at the time of their diagnosis and 662 of these patients stopped smoking prior to surgery. Current smokers were generally younger, had a lower body mass index, and were more likely to experience a ≥12-week delay between diagnosis and surgery than former smokers. Current smokers were also more likely to have higher-grade tumors than former smokers. Pharmacotherapy for smoking cessation was offered to 1351 of the current smokers between diagnosis and surgery. Preoperative interventions that were associated with smoking cessation included prescribing smoking cessation pharmacotherapy, more frequent medical encounters, and an appointment with a primary care provider. Delaying surgery and the number of packs smoked per year had no association with smoking cessation likelihood.
Evaluation of the relationship between smoking cessation duration and the 30-day outcome of major complication or mortality revealed that there was a higher risk for complications or mortality associated with a higher Charlson comorbidity score and larger tumor size and a lower risk with a longer duration between smoking cessation and surgery and with a video-assisted thoracoscopic surgery approach. Those patients who ceased smoking ≥3 weeks prior to surgery had similar complication odds as nonsmokers (95% confidence interval, 0.702-1.437; P = .98). Those patients who continued to smoke had a shorter overall 5-year survival rate (56.1%) compared with a 61.7% survival rate among those patients who ceased smoking. The odds of major complications or mortality had a decrease of 8.1% for each week of successful smoking cessation prior to surgery.
Source
Heiden BT, Eaton DB Jr, Chang SH, et al. Assessment of duration of smoking cessation prior to surgical treatment of non-small cell lung cancer [published online ahead of print, November 18, 2021]. Ann Surg. 2021;10.1097/SLA.0000000000005312.
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