Riccardo Tellini1, Andrea Mari1, Gianluca Muto1, Giovanni Enrico Cacciamani2, Matteo Ferro3, Judith Stangl-Kremser4, Riccardo Campi1, Francesco Soria5, Michael Rink6, Evanguelos Xylinas7, Andrea Minervini1, Alberto Briganti8, Francesco Montorsi8, Morgan Roupret9, Shahrokh F Shariat10, Marco Moschini11. 1. Department of Urology, Careggi Hospital, University of Florence, Florence, Italy. 2. USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. 3. Division of Urology, European Institute of Oncology-IRCCS, Milan, Italy. 4. Department of Urology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria. 5. Division of Urology, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy. 6. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 7. Department of Urology, Bichat-Claude Bernard Hospital, APHP, Paris University, Paris, France. 8. Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy. 9. Urology, GRC 5 PREDICTIVE ONCO-URO, AP-HP, Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France. 10. Department of Urology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Department of Urology, University of Jordan, Amman, Jordan; European Association of Urology research foundation, Arnhem, The Netherlands. 11. Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland. Electronic address: marco.moschini87@gmail.com.
Abstract
CONTEXT: Smoking habit at the time of surgery is associated with higher perioperative complications and mortality across different types of surgeries. In recent years, several studies have attempted to explore the influence of smoking on perioperative outcomes following radical cystectomy (RC) for urothelial bladder cancer (UBC) with contradictory results. OBJECTIVE: To systematically investigate and meta-analyze the association between smoking habit and perioperative morbidity and mortality in UBC patients treated with RC. EVIDENCE ACQUISITION: A systematic review of the literature published between January 2000 and January 2020 investigating the impact of smoking habit on perioperative outcomes of patients treated with RC for UBC was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and the Cochrane Handbook for Systematic Reviews of Interventions. EVIDENCE SYNTHESIS: Overall, 27 articles involving 27 854 patients were included in the systematic review, and of these, 11 studies were included in the meta-analysis. The studies included showed a moderate to high risk of bias. Smoking status (smokers vs nonsmokers) was significantly associated with the onset of major postoperative complications (hazard ratio [HR] 1.87, 95% confidence interval [CI] 1.51-2.32; I2 = 0%), infections (HR 1.34, 95% CI 1.02-1.72; I2 = 66.2%), and mortality (HR 1.84, 95% CI 1.14-2.98; I2 = 4.9%). CONCLUSIONS: Smoking status at the time of RC is associated with increased risk for major postoperative complications, infections, and mortality. These results suggest the need for strict postoperative monitoring in smokers due to the increased risk of experiencing adverse events and underline the need for intensive smoking cessation interventions in the preoperative setting. PATIENT SUMMARY: In this study, we reviewed the impact of smoking habit on perioperative outcomes following radical cystectomy (RC). Based on the available data, the impact of smoking on morbidity and mortality after RC is significant and relevant; as such, every effort should be made in the preoperative setting to encourage smoking cessation.
CONTEXT: Smoking habit at the time of surgery is associated with higher perioperative complications and mortality across different types of surgeries. In recent years, several studies have attempted to explore the influence of smoking on perioperative outcomes following radical cystectomy (RC) for urothelial bladder cancer (UBC) with contradictory results. OBJECTIVE: To systematically investigate and meta-analyze the association between smoking habit and perioperative morbidity and mortality in UBC patients treated with RC. EVIDENCE ACQUISITION: A systematic review of the literature published between January 2000 and January 2020 investigating the impact of smoking habit on perioperative outcomes of patients treated with RC for UBC was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and the Cochrane Handbook for Systematic Reviews of Interventions. EVIDENCE SYNTHESIS: Overall, 27 articles involving 27 854 patients were included in the systematic review, and of these, 11 studies were included in the meta-analysis. The studies included showed a moderate to high risk of bias. Smoking status (smokers vs nonsmokers) was significantly associated with the onset of major postoperative complications (hazard ratio [HR] 1.87, 95% confidence interval [CI] 1.51-2.32; I2 = 0%), infections (HR 1.34, 95% CI 1.02-1.72; I2 = 66.2%), and mortality (HR 1.84, 95% CI 1.14-2.98; I2 = 4.9%). CONCLUSIONS: Smoking status at the time of RC is associated with increased risk for major postoperative complications, infections, and mortality. These results suggest the need for strict postoperative monitoring in smokers due to the increased risk of experiencing adverse events and underline the need for intensive smoking cessation interventions in the preoperative setting. PATIENT SUMMARY: In this study, we reviewed the impact of smoking habit on perioperative outcomes following radical cystectomy (RC). Based on the available data, the impact of smoking on morbidity and mortality after RC is significant and relevant; as such, every effort should be made in the preoperative setting to encourage smoking cessation.
Authors: Alana M Rojewski; Lisa M Fucito; Nathaniel L Baker; Amanda M Palmer; Madeline G Foster; Graham W Warren; Steven L Bernstein; Benjamin A Toll Journal: BMJ Open Date: 2021-06-29 Impact factor: 2.692