Amy M. Holmstrom

Impact of preoperative smoking status on postoperative complication rates and pulmonary function test results 1-year following pulmonary resection for non-small cell lung cancer

There is a lack of evidence in the literature regarding the impact of preoperative smoking status on pulmonary function test (PFT) results 1 year after resection for non-small cell lung cancer (NSCLC). Furthermore, there is disagreement in the literature regarding the impact of preoperative smoking cessation on postoperative complication rates. We performed a single-institution retrospective review of all NSCLC patients who underwent resection from April 2000 through April 2006. Timing of smoking cessation was stratified as follows: smoking cessation more than a month before surgery (Distant Smokers), smoking cessation within a month before surgery (Recent Smokers), and failure to achieve smoking cessation before surgery (Current Smokers). During the study period, 213 patients underwent NSCLC resection, 121 of whom (all males; mean age, 67.4 years) completed pre- and postoperative PFTs. After adjusting for potential confounding covariates (age, type of resection, and use of radiation therapy), we noted no significant difference (p>0.40) between groups after resection with regard to either relative (-12.20+/-15.77L [Distant Smokers], -15.38+/-19.38L [Recent Smokers], -9.61+/-15.54L [Current Smokers]) or absolute changes in percent predicted forced expiratory volume in 1s (-0.14+/-0.20L [Distant Smokers], -0.18+/-0.19L [Recent Smokers], -0.12+/-0.20L [Current Smokers]). Because 92 patients did not complete postoperative PFTs, we performed a stratified analysis to assess for selection bias; as compared with those who completed PFTs, baseline PFT results did not significantly differ. We found no significant differences between the 3 groups with regard the overall rate of postoperative complications or the rate of any specific postoperative complication. In conclusion, smoking cessation immediately before NSCLC resection does not significantly impact postoperative pulmonary complication rates or 1-year postoperative PFT results and therefore should not be a reason to delay surgical resection.