The effect of preoperative smoking cessation and smoking dose on postoperative complications following radical gastrectomy for gastric cancer: a retrospective study of 2469 patients

BackgroundTo investigate whether smoking adversely affects the short-term outcomes and the potential effects of cigarette dose and preoperative smoking cessation, in patients who underwent gastric cancer (GC) surgery.MethodsTwo thousand, four hundred sixty-nine consecutive patients who underwent radical gastrectomy from November 2010 to July 2018 were included in the present study. Smokers (current or former smokers) were divided into 3 groups in accordance with the duration of smoking cessation preoperatively (2, 2 to 4, or 4weeks) and the cigarette dose (20, 20 to 40, and 40 pack-years). The primary endpoint was postoperative complications (surgical site infection, pulmonary problems, bleeding, and others).ResultsA total of 1056 patients (42.8%) were smokers. Compared with non-smokers, smokers had significantly higher overall postoperative complications (11.3% vs 7.5%, P=0.001), and in particular pulmonary problems. Smokers also had more major complications, needing intensive care unit care, and longer postoperative hospital stays. Multivariate analysis confirmed that smoking (odds ratio=1.506, 95% confidence interval 1.131-2.004, P=0.005) was an independent risk factor for postoperative complications. Further subgroup analysis identified that there was a positive relationship between the incidence of complications and cigarette dose, and >20 pack-years was demonstrated to have increased significantly the risk of complications. Smokers who stopped smoking 4weeks before surgery had lower pulmonary problems than those with a shorter period of smoking cessation.ConclusionsPreoperative smoking cessation should be encouraged to reduce postoperative complications in GC patients, especially for heavy smokers.