SESSION TYPE: Thoracic Surgery Posters II
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: Current smoking increases the risk of perioperative complications (especially respiratory failure and bronchial stump breakdown) in patients undergoing pneumonectomy, but has not clearly been shown to significantly increase operative risk in lesser procedures. Further, no data on the relative risk of thoracoscopic resections in patients who smoke and who do not has been reported. We report a prospective comparison of the perioperative risk and mortality between non-smoking and smoking patients undergoing lung resections.
METHODS: All our patients undergoing thoracic surgery were questioned about their smoking history and blood tests obtained for carboxyhemoglobin (CBH). Patients were considered smokers if they had smoked within two weeks of surgery or if CBH was elevated. Standard demographic data were collected, as was length of stay, perioperative complications (life-threatening, major, and minor), perioperative mortality and three year survival. Means were compared using student’s t test, and proportions using chi-square. Standard significance parameters were used.
RESULTS: 168 patients (60 smokers and 108 non-smokers) over two years underwent resection (wedge resection, segmentectomy, or lobectomy). No significant differences were found in the ages (smokers=61.1 years, nonsmokers=66.0), nor any significant demographic data (fraction of patients undergoing wedge resections, segmentectomies, or lobectomies, nor the fraction of men and women). The non-smokers did have more life-threatening complications (LTC) (Two versus six, p=0.04941), but no differences were seen in the overall incidence of complications (p=0.96). Further, no difference was seen in the perioperative mortality (no operative mortality in either group in this cohort). Finally, no difference in three year survival between smokers and non-smokers was seen.
CONCLUSIONS: Our data demonstrate that pre-operative smoking in patients undergoing thoracoscopic resections increases perioperative risk but does not increase perioperative mortality. Further, it did not affect short-term survival. These data suggest that resection can be planned in most smoking patients, as long as pneumonectomy is not expected.
CLINICAL IMPLICATIONS: Smoking patients who develop lung cancer can safely undergo resection if resection less than pneumonectomy is planned.
DISCLOSURE: John Roberts: Consultant fee, speaker bureau, advisory committee, etc.: Product development with Medtronic, Consultant fee, speaker bureau, advisory committee, etc.: Faculty instructor with Ethicon
The following authors have nothing to disclose: Timothy Roberts, Aravindhan Sriharan
No Product/Research Disclosure InformationThe Surgical Clinic, Sarah Cannon Cancer Center, Nashville, TN