Naoya Yoshida1,2, Kenichi Nakamura1, Daisuke Kuroda1, Yoshifumi Baba1, Yuji Miyamoto1, Masaaki Iwatsuki1, Yukiharu Hiyoshi1, Takatsugu Ishimoto1,2, Yu Imamura3, Masayuki Watanabe3, Hideo Baba4. 1. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuoku, Kumamoto, 860-8556, Japan. 2. Division of Translational Research and Advanced Treatment Against Gastrointestinal Cancer, Kumamoto University, 1-1-1 Honjo, Chuoku, Kumamoto, 860-8556, Japan. 3. Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan. 4. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuoku, Kumamoto, 860-8556, Japan. hdobaba@kumamoto-u.ac.jp.
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.
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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