PURPOSE: To assess whether preoperative smoking cessation improves pulmonary function tests (PFTs) one year after resection of non-small cell lung cancer (NSCLC).
METHODS: A single institution retrospective review was conducted of all NSCLC patients who underwent resection between April 2000 and April 2006. Patient characteristics, Karnofsky scores, smoking history, type of resection, pathologic stage, length of stay, complications, and preoperative and one-year postoperative PFT results were collected. Timing of smoking cessation was stratified as follows: smoking cessation more than a month before surgery (Group 1), smoking cessation within a month of surgery (Group 2), and current smokers (Group 3). Analysis of variance was utilized to compare changes in PFTs between smoking groups. Results are reported as mean ± standard deviation.
RESULTS: During the study period, 220 patients underwent NSCLC resection, 124 of which (122 males; mean age 67.3 years) completed preoperative and postoperative PFTs. After adjusting for potential confounding covariates (including type of resection), there was no significant difference (p>0.40) between groups with regards to either relative or absolute changes in PFTs: preoperative forced expiratory volume in 1 second (FEV1) 2.15 ± 0.68L (Group 1), 2.35 ± 0.82L (Group 2), 2.14 ± 0.64L (Group 3), postoperative FEV1 1.81 ± 0.61L (Group 1), 1.88 ± 0.78L (Group 2), 1.81 ± 0.56L (Group 3). There were no significant differences between the groups with regards to pathologic stage, complications, or length of stay. Since 96 of the 220 patients who underwent NSCLC resection didn't complete postoperative PFTs, we performed a stratified analysis to assess for selection bias. The patients who didn't complete postoperative PFTs had a significantly higher prevalence of diabetes. There were no other significant differences with regards to other covariates (including percent predicted FEV1).
CONCLUSION: Timing of smoking cessation relative to NSCLC resection does not significantly impact one-year postoperative PFTs. Smoking status should not alter the timing or extent of resection.
CLINICAL IMPLICATIONS: Concerns regarding postoperative pulmonary function should not mandate smoking cessation before resection of NSCLC.
DISCLOSURE: Shawn Groth, No Financial Disclosure Information; No Product/Research Disclosure Information