Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Eur Urol Oncol. 2021 Aug;4(4):580-593. doi: 10.1016/j.euo.2020.10.006. Epub 2020 Nov 5.
Smoking habit at the time of surgery is associated with higher perioperative complications and mortality across different types of surgeries. In recent years, several studies have attempted to explore the influence of smoking on perioperative outcomes following radical cystectomy (RC) for urothelial bladder cancer (UBC) with contradictory results.
To systematically investigate and meta-analyze the association between smoking habit and perioperative morbidity and mortality in UBC patients treated with RC.
A systematic review of the literature published between January 2000 and January 2020 investigating the impact of smoking habit on perioperative outcomes of patients treated with RC for UBC was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and the Cochrane Handbook for Systematic Reviews of Interventions.
Overall, 27 articles involving 27 854 patients were included in the systematic review, and of these, 11 studies were included in the meta-analysis. The studies included showed a moderate to high risk of bias. Smoking status (smokers vs nonsmokers) was significantly associated with the onset of major postoperative complications (hazard ratio [HR] 1.87, 95% confidence interval [CI] 1.51-2.32; I = 0%), infections (HR 1.34, 95% CI 1.02-1.72; I = 66.2%), and mortality (HR 1.84, 95% CI 1.14-2.98; I = 4.9%).
Smoking status at the time of RC is associated with increased risk for major postoperative complications, infections, and mortality. These results suggest the need for strict postoperative monitoring in smokers due to the increased risk of experiencing adverse events and underline the need for intensive smoking cessation interventions in the preoperative setting.
In this study, we reviewed the impact of smoking habit on perioperative outcomes following radical cystectomy (RC). Based on the available data, the impact of smoking on morbidity and mortality after RC is significant and relevant; as such, every effort should be made in the preoperative setting to encourage smoking cessation.
手术时的吸烟习惯与不同类型手术的围手术期并发症和死亡率升高有关。近年来，多项研究试图探讨吸烟对接受根治性膀胱切除术（RC）治疗的尿路上皮膀胱癌（UBC）患者围手术期结局的影响，但结果相互矛盾。
系统研究并荟萃分析吸烟习惯与接受 RC 治疗的 UBC 患者围手术期发病率和死亡率之间的关系。
根据系统评价和荟萃分析的首选报告项目（PRISMA）声明和 Cochrane 干预系统评价手册，对 2000 年 1 月至 2020 年 1 月期间发表的研究吸烟习惯对接受 RC 治疗的 UBC 患者围手术期结局影响的文献进行系统回顾。
总体而言，系统评价纳入了 27 项研究，共涉及 27854 名患者，其中 11 项研究纳入荟萃分析。纳入的研究显示存在中高度偏倚风险。吸烟状态（吸烟者与非吸烟者）与主要术后并发症的发生显著相关（风险比[HR]1.87，95%置信区间[CI]1.51-2.32；I=0%）、感染（HR 1.34，95%CI 1.02-1.72；I=66.2%）和死亡率（HR 1.84，95%CI 1.14-2.98；I=4.9%）。
RC 时的吸烟状态与术后主要并发症、感染和死亡率增加的风险相关。这些结果表明，由于吸烟者发生不良事件的风险增加，需要对其进行严格的术后监测，并强调需要在术前加强戒烟干预。
在这项研究中，我们回顾了吸烟习惯对根治性膀胱切除术（RC）后围手术期结果的影响。基于现有数据，吸烟对 RC 后发病率和死亡率的影响是显著且相关的；因此，应在术前尽最大努力鼓励戒烟。
