Researchers at the University of Cincinnati College of Medicine have found that patients who continue to smoke ahead of lung cancer surgery have a higher risk of pulmonary complications, but their short-term mortality rate is similar to patients who were able to stop smoking before surgery.
Published in the Journal of American College of Surgeons , the findings suggest physicians reconsider a traditional model that eliminates certain patients still smoking up until the time of treatment from lung cancer surgery. Physicians traditionally want patients to stop smoking one month before surgery, but more individualized plans for patients may offer healthier options.
"Smoking is obviously very bad and is associated with developing cancer and heart disease. And in our study, it shows it does increase the chance of post-operative complications," says Robert Van Haren, MD, a University of Cincinnati Cancer Center researcher and associate professor of clinical surgery in the UC College of Medicine.
"We really want patients not to smoke and to quit smoking before surgery. However, if some patients are unable or unwilling to quit smoking, we still can safely offer surgery for treatment of their lung cancer," adds Van Haren, also a UC Health surgeon and corresponding author for the study.
"There is no difference in the chance of dying, so we can still get them through the operation, but we have to be careful and make that decision on an individual basis rather than looking at one factor in making our decision about surgery," says Van Haren.
UC researchers analyzed lung cancer resections outcomes of 85,124 patients registered from 2018 to 2023 in the Society of Thoracic Surgeons General Thoracic Surgery Database. They found patients who were current smokers were younger and had fewer comorbidities.
Pulmonary complications were more frequent among patients who currently smoked — 34.6% versus 30.5% — but mortality didn't differ by smoking status, with the rate at 1% for both individuals currently smoking and those who quit before the surgery.
Van Haren says the findings suggest association and not causation. He added that surgeons will consider several factors for patients, including age, whether they are walking or in a wheelchair, and whether the cancer can only be done safely with thoracotomy.
Traditionally, the standard for treatment for a lot of cancers was for surgeons to remove a larger section of the lung, explains Van Horen. But the increased use of robot-assisted surgery has changed treatment options.
"We are doing a lot of surgery robotically with smaller incisions so that it allows patients to recover better and have less chance of developing problems like pneumonia compared to open incisions with thoracotomy," says Van Haren. "There are changes in technology and in our knowledge that allow us to offer the surgery to more patients."
The study's lead author was Hannah Kim, MD, a recent medical school graduate at UC. Other UC College of Medicine co-authors include Sofia Wagemaker Viana, MD, a cardiothoracic research fellow; Christiana Pinkson, a research associate in the College of Medicine; and Catherine Pratt, medical resident.
Additional co-authors include Shesh Rai, PhD, a Cancer Center member in the Experimental Therapeutics Research Program and director of the Cancer Center's Biostatistics & Informatics Shared Resource; Sandra Starnes, MD, Division Chief of Cardiothoracic Surgery at UC College of Medicine and UC Health and a Cancer Center member; Christine Haugen, MD, PhD, assistant professor of surgery and UC Health surgeon; and Ralph Quillin III, MD, assistant professor of surgery and UC Health surgeon.
