根治性肺癌手术后吸烟及戒烟时间对术后肺部并发症的影响
Smoking and timing of cessation on postoperative pulmonary complications after curative-intent lung cancer surgery.
作者信息
Lugg Sebastian T, Tikka Theofano, Agostini Paula J, Kerr Amy, Adams Kerry, Kalkat Maninder S, Steyn Richard S, Rajesh Pala B, Bishay Ehab, Thickett David R, Naidu Babu
机构信息
Centre for Translational Inflammation Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2WB, UK.
Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK.
出版信息
J Cardiothorac Surg. 2017 Jun 19;12(1):52. doi: 10.1186/s13019-017-0614-4.
BACKGROUND
Smoking is a risk factor for postoperative pulmonary complications (PPC) following non-small cell lung cancer (NSCLC) surgery. The optimal timing for preoperative smoking cessation has not been identified. Our study aimed to observe the impact of preoperative smoking cessation on PPC incidence and other postoperative outcomes including long-term survival.
METHODS
A prospective study included consecutive patients following resection for NSCLC in a regional thoracic centre over a 4-year period (2010-2014). Patients were stratified according to self-reported preoperative smoking status. The primary endpoint was PPC incidence, which was assessed from postoperative day one onwards using the Melbourne Group Scale. Secondary endpoints included short-term outcomes (hospital length of stay [LOS], intensive therapy unit [ITU] admission, 30-day hospital readmission rate) and long-term survival.
RESULTS
Four hundred and sixty-two patients included 111 (24%) current smokers, 55 (12%) ex-smokers <6 weeks, 245 (53%) ex-smokers ≥6 weeks and 51 (11%) never smokers. PPC occurred in 60 (13%) patients in total. Compared to never smokers, current smokers had a higher frequency of PPC (22% vs. 2%, p = 0.004), higher frequency of ITU admission (14% vs. 0%; p = 0.001) and a longer median (IQR) hospital LOS (6 [5] vs. 5 [2]; p = 0.001). In the ex-smokers there was a trend for a lower frequency of PPC (<6 weeks, 10.9% vs. ≥6 weeks, 11.8%) and ITU admission (<6 weeks, 5.5% vs. ≥6 weeks, 4.5%), but there was no difference between the <6 weeks or ≥6 weeks ex-smoking groups prior to surgery. There was no significant difference in long-term survival found between the groups of differing smoking status (median follow-up 29.8 months, 95%CI 28.4-31.1).
CONCLUSION
Current smokers have higher postoperative morbidity; this risk reduces following smoking cessation but 6 weeks does not appear to identify a time-point where differences in outcomes are noted.
背景
吸烟是非小细胞肺癌（NSCLC）手术后发生术后肺部并发症（PPC）的一个风险因素。术前戒烟的最佳时机尚未确定。我们的研究旨在观察术前戒烟对PPC发生率以及包括长期生存在内的其他术后结局的影响。
方法
一项前瞻性研究纳入了某地区胸科中心在4年期间（2010 - 2014年）连续接受NSCLC切除术的患者。患者根据自我报告的术前吸烟状况进行分层。主要终点是PPC发生率，从术后第1天起使用墨尔本组量表进行评估。次要终点包括短期结局（住院时间[LOS]、重症监护病房[ITU]入院、30天再入院率）和长期生存。
结果
462例患者中包括111例（24%）当前吸烟者、55例（12%）戒烟时间<6周的既往吸烟者、245例（53%）戒烟时间≥6周的既往吸烟者和51例（11%）从不吸烟者。总共60例（13%）患者发生了PPC。与从不吸烟者相比，当前吸烟者的PPC发生率更高（22%对2%，p = 0.004），ITU入院频率更高（14%对0%；p = 0.001），且中位（IQR）住院LOS更长（6[5]对5[2]；p = 0.001）。在既往吸烟者中，PPC发生率（<6周，10.9%对≥6周，11.8%）和ITU入院率（<6周，5.5%对≥6周，4.5%）有降低趋势，但术前<6周或≥6周的既往吸烟组之间无差异。不同吸烟状态组之间的长期生存无显著差异（中位随访29.8个月，95%CI 28.4 - 31.1）。
结论
当前吸烟者术后发病率更高；戒烟后这种风险降低，但6周似乎并未确定一个能观察到结局差异的时间点。
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