A large study analyzing outcomes in patients with esophageal squamous cell carcinoma found that those who smoked prior to surgery could face higher rates of major complications, particularly pulmonary issues, compared with those who never smoked.
In the study, investigators included 694 patients who underwent esophagectomy between 1996 and 2019 at a high-volume medical center in France. They grouped patients by smoking history at the time of diagnosis: 597 were smokers (either active or former), and 97 were never-smokers.
Thirty-seven percent of smokers developed major postoperative complications compared with 23% of nonsmokers. Pulmonary complications were more common among smokers, affecting 29% vs 21% of nonsmokers. Pneumonia specifically occurred in 15% of smokers versus 7.2% of nonsmokers. These complications included severe conditions such as acute respiratory distress syndrome (ARDS).
Among active smokers—defined as those who continued smoking within 6 weeks of surgery—the 30-day mortality rate was 5.1% compared with 1.2% in former smokers. ARDS occurred in 11% of active smokers and 5.3% of those who had quit.
While nonsmokers appeared to have longer median overall survival times (56.4 months vs 33.1 months), smoking status didn't independently impact long-term outcomes when other clinical factors were considered. In multivariate analysis, factors such as sex, nutritional status, cancer stage, and resection margins were more predictive of survival than smoking history.
The investigators used a standardized grading system for complications and accounted for factors like age, comorbidities, and chronic obstructive pulmonary disease, which was more prevalent in smokers.
Among the 412 patients (about 59% of the cohort) who received preoperative chemoradiotherapy, there was no statistically significant difference in treatment response between smokers and nonsmokers.
A key limitation of the study was its lack of data on smoking behavior after surgery, making it difficult to determine the effect of continued smoking on long-term outcomes. Previous studies have shown that quitting smoking following a cancer diagnosis may improve survival, underscoring the importance of cessation support.
While the investigators defined former smokers as those who had quit at least 6 weeks prior to surgery, data suggested that stopping at least 2 months prior to the procedure may further reduce risks such as ARDS and early mortality.
The findings add to existing evidence that smoking raises the risk of short-term surgical complications in patients with esophageal squamous cell carcinoma. Although it may not directly affect long-term survival when other clinical factors are controlled, smoking cessation remains a critical part of preoperative care.
The authors reported no conflicts of interest.
Source: Surgery
