It's never too late to quit smoking before lung surgery

By Carolyn Crist

(Reuters Health) - 16/1/2019

Smokers preparing for lung cancer surgery should quit smoking before the operation, and the sooner the better, a new study shows.

Among patients who had surgery for lung cancer, nonsmokers had fewer complications than smokers. But quitting even just a few months before surgery reduced patients' risks of complications.

"Even a short period of four weeks of preoperative cessation may contribute to a major risk reduction," said Dr. David Lindstrom of Uppsala Academic Hospital in Sweden, who wasn't involved with the new study.

Previous studies indicate that about a third of patients are current smokers at the time of diagnosis, and 20% are current smokers at the time of surgery, Mariko Fukui and colleagues at the Juntendo University School of Medicine in Tokyo wrote in their report of the study, published online January 2 in Annals of Thoracic Surgery.

The researchers studied 666 patients who had surgery for lung cancer between 2012-2016, including 256 never-smokers and 410 current or previous smokers.

During the three months following the operations, about 32% of current smokers had respiratory complications, compared to 22% of previous smokers and 3.5% of non-smokers. Generally, smokers were older, had poorer lung function, needed longer operations, and lost more blood during surgery.

The more time that elapsed since smokers had quit, the lower their risk of postoperative problems. Complication rates were 13% for current smokers, 10% for patients who stopped smoking less than a month before surgery, 8.5% for people who quit one to three months before surgery, 6.3% for three to six months, 6% for six months to a year, and 5% for former smokers who had quit more than a year before their surgery.

"Lung surgery outcomes are not only linked to long-term survival but to quality of life, and lung resection and lung cancer tend to decrease both of them," said Dr. Maria Rodriguez Perez of Clinica Universidad de Navarra in Madrid, Spain, who researches lung cancer and surgery outcomes but wasn't involved in this study.

"Nowadays, we tend to look at the patient as a whole, focusing not only on the specific pathology but on other systems that interact and could have a detrimental effect on outcomes," she told Reuters Health by email. "Smoking cessation should be, without a doubt, one of the pillars of these programs."

"Any kind of forthcoming surgical procedure is a good time to try to stop smoking," said Lindstrom, who has studied the effect of smoking cessation on outcomes of orthopedic surgery. "And when you decide to deal with it," he tells patients, "take all the help you can get with motivational counseling, websites, apps and professionals."

SOURCE: Ann Thorac Surg 2019.

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