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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2022

27-08-2022 | Esophageal Cancer | Thoracic Oncology

Preoperative Smoking Cessation and Prognosis After Curative Esophagectomy for Esophageal Cancer: A Cross-Sectional Study

Authors: Naoya Yoshida, MD, PhD, Kojiro Eto, MD, PhD, Tomo Horinouchi, MD, Kazuto Harada, MD, PhD, Hiroshi Sawayama, MD, PhD, Katsuhiro Ogawa, MD, PhD, Yohei Nagai, MD, PhD, Masaaki Iwatsuki, MD, PhD, Shiro Iwagami, MD, PhD, Takatsugu Ishimoto, MD, PhD, Yoshifumi Baba, MD, PhD, Yuji Miyamoto, MD, PhD, Hideo Baba, MD, PhD

Published in: Annals of Surgical Oncology | Issue 13/2022

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Abstract

Background

Several cohort studies have reported that post-esophagectomy morbidities may worsen prognosis. Smoking cessation is an effective prophylactic measure for reducing post-esophagectomy morbidity; however, whether smoking cessation can contribute to the improvement of prognosis is unknown due to the absence of reliable databases covering the cessation period. This study aimed to elucidate whether sufficient preoperative smoking cessation can improve prognosis after esophageal cancer surgery by reducing post-esophagectomy morbidity.

Methods

This study included 544 consecutive patients who underwent curative McKeown and Ivor–Lewis esophagectomies for esophageal cancer between May 2011 and June 2021. Data on smoking status and cessation period were prospectively accumulated. Survival data were finally updated on 30 January 2022. Receiver operating characteristic curve analysis for the cut-off value of appropriate cessation period in reducing post-esophagectomy respiratory morbidity as well as analyses for the association of cessation period with short- and long-term outcomes were performed.

Results

Post-esophagectomy morbidity significantly diminished overall survival (OS) after esophagectomy (p = 0.0003). A short preoperative smoking cessation period of ≤ 2 months was associated with frequent post-esophagectomy morbidity of Clavien–Dindo classification ≥IIIb (p = 0.0059), pneumonia (p = 0.016), respiratory morbidity (p = 0.0057), and poor OS in clinical stages II and III (p = 0.0015). Moreover, it was an independent factor for poor OS (hazard ratio 1.85, 95% confidence interval 1.068–3.197; p = 0.028), along with body mass index <18.5 and R1 resection.

Conclusions

Sufficient preoperative smoking cessation > 2 months may be effective in improving not only short-term outcomes but also prognosis after esophagectomy for locally advanced esophageal cancer.
Appendix
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Metadata
Title
Preoperative Smoking Cessation and Prognosis After Curative Esophagectomy for Esophageal Cancer: A Cross-Sectional Study
Authors
Naoya Yoshida, MD, PhD
Kojiro Eto, MD, PhD
Tomo Horinouchi, MD
Kazuto Harada, MD, PhD
Hiroshi Sawayama, MD, PhD
Katsuhiro Ogawa, MD, PhD
Yohei Nagai, MD, PhD
Masaaki Iwatsuki, MD, PhD
Shiro Iwagami, MD, PhD
Takatsugu Ishimoto, MD, PhD
Yoshifumi Baba, MD, PhD
Yuji Miyamoto, MD, PhD
Hideo Baba, MD, PhD
Publication date
27-08-2022
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 13/2022
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-022-12433-z

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