Does Smoking Status Have an Impact on Postoperative Complications After Lung Cancer Resection? An Analysis of the National Lung Screening Trial.

Authors

Moore AN, Mathur M, Pratt CG, Pinkston C, Rai S, Quillin RC, Van Haren RM

Affiliations

• Cincinnati Research in Outcomes and Safety in Surgery (CROSS) Research Group, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.

Abstract

BACKGROUND: Mandatory smoking cessation before surgical resection for lung cancer may worsen racial disparities, increasing barriers to treatment without a proven risk reduction in postoperative complications. This study compares postoperative complications regarding current and former smoking status of patients undergoing lung cancer resection.

METHODS: Study data were drawn from the National Lung Screening Trial. Inclusion criteria included lung cancer diagnosis and pretreatment staging or IA, IB, IIA, or IIB. These patients were stratified by self-reported current or former smoking status.

RESULTS: Of 862 patients from the National Lung Screening Trial who met inclusion criteria, 45% (n = 379) had former smoking status and 55% (n = 483) had current smoking status. Those with current smoking status were more often racial minorities (10.7% vs 5.0%; P = .005), were younger (62.9 vs 64.5 years; P < .001), had squamous cell carcinoma (28.0% vs 24.5%; P = .03), and had less heart disease (12.4% [n = 60] vs 17.4% [n = 66]; P = .04) Current smoking status was associated with increased moderate/major complications (P = .04) but not all complications (P = .06). There was no difference in mortality rates between current and former smoking status patients (4.3% vs 2.4%; P = .12).

CONCLUSIONS: Current smoking status is associated with increased risk of moderate/major complications after lung cancer resection; however, there was no difference in mortality rate. Surgeons should offer smoking cessation, although requiring cessation before surgical resection may worsen racial disparities by limiting access to surgery.