Yoshida Naoya, Nakamura Kenichi, Kuroda Daisuke, Baba Yoshifumi, Miyamoto Yuji, Iwatsuki Masaaki, Hiyoshi Yukiharu, Ishimoto Takatsugu, Imamura Yu, Watanabe Masayuki, Baba Hideo
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuoku, Kumamoto, 860-8556, Japan.
Division of Translational Research and Advanced Treatment Against Gastrointestinal Cancer, Kumamoto University, 1-1-1 Honjo, Chuoku, Kumamoto, 860-8556, Japan.
World J Surg. 2018 Sep;42(9):2902-2909. doi: 10.1007/s00268-018-4572-3.
Preoperative smoking cessation is considered integral to decreasing postoperative morbidities after esophagectomy. To our knowledge, the association of the duration of smoking cessation with the occurrence of postoperative morbidity has never been investigated in minimally invasive esophagectomy (MIE).
A total of 198 consecutive MIEs for esophageal cancer between June 2011 and December 2017 were eligible for the study. According to the length of smoking cessation, patients were separated into three groups: ≤ 30, 31-90, and ≥ 91 days. Incidence of postoperative morbidities was retrospectively analyzed among the groups.
In patients with smoking cessation ≤ 30 days, morbidities of Clavien-Dindo classification (CDc) ≥ II, severe morbidities of CDc ≥ IIIb, pneumonia, and any pulmonary morbidities were frequently observed. Morbidities of CDc ≥ II, pneumonia, and any pulmonary morbidities increased as the length of cessation became shorter. Smoking cessation ≤ 30 days was a significant risk factor for severe morbidity (hazard ratio [HR] 4.89, 95% confidence interval [CI] 1.993-12.011; P < 0.001). Smoking cessation ≤ 90 days (HR 3.98, 95% CI 1.442-10.971; P = 0.008), past smoking (per 100 increase in Brinkman index), and cardiovascular comorbidity were significant risk factors for pneumonia. Smoking cessation ≤ 30 days (HR 3.13, 95% CI 1.351-7.252; P = 0.008) and past smoking were significant risk factors for any pulmonary morbidity.
Preoperative smoking cessation is considerably important to prevent postoperative morbidities, even in MIE. At least, preoperative cessation ≥ 31 days is preferable to decrease considerable morbidities after MIE.
术前戒烟被认为是降低食管癌切除术后发病率不可或缺的措施。据我们所知，在微创食管癌切除术（MIE）中，戒烟持续时间与术后发病率的关联从未被研究过。
2011年6月至2017年12月期间连续进行的198例食管癌MIE患者符合本研究条件。根据戒烟时间长短，患者被分为三组：≤30天、31 - 90天和≥91天。对各组术后发病率进行回顾性分析。
在戒烟≤30天的患者中，经常观察到Clavien - Dindo分类（CDc）≥II级的并发症、CDc≥IIIb级的严重并发症、肺炎以及任何肺部并发症。随着戒烟时间缩短，CDc≥II级的并发症、肺炎和任何肺部并发症的发生率增加。戒烟≤30天是严重并发症的显著危险因素（风险比[HR] 4.89，95%置信区间[CI] 1.993 - 12.011；P < 0.001）。戒烟≤90天（HR 3.98，95% CI 1.442 - 10.971；P = 0.008）、既往吸烟（Brinkman指数每增加100）和心血管合并症是肺炎的显著危险因素。戒烟≤30天（HR 3.13，95% CI 1.351 - 7.252；P = 0.008）和既往吸烟是任何肺部并发症的显著危险因素。
即使在MIE中，术前戒烟对于预防术后并发症也相当重要。至少，术前戒烟≥31天对于降低MIE术后的严重并发症是更可取的。
