AdventHealth Tampa, Tampa, FL, USA.
Advent Health West Florida, Tampa, FL, USA.
Am Surg. 2023 Sep;89(9):3764-3770. doi: 10.1177/00031348231173934. Epub 2023 May 24.
The detrimental effects that smoking has on patient health and postoperative morbidity are well documented. However, literature on the impact that smoking history has on robotic surgery, specifically robotic hepatectomy, is scarce. This study was undertaken to determine whether smoking history impacts the postoperative course of patients undergoing robotic hepatectomy.
We prospectively followed 353 patients that underwent robotic hepatectomy. 125 patients had an apposite history of smoking (ie, smokers) and 228 patients were classified as non-smokers. Data were presented as median (mean ± SD). Patients were then propensity-score matched based on patient and tumor characteristics.
Prior to the matching, the MELD score and cirrhosis status in patients who smoke were found to be significantly higher when compared to those who do not (mean MELD score 9 vs 8 and cirrhosis in 25% vs 13% of patients, respectively). Both smokers and non-smokers have similar BMIs, number of previous abdominal operations, ASA physical status classifications, and Child-Pugh scores. Six percent smokers vs one percent non-smokers experienced pulmonary complications (pneumonia, pneumothorax, and COPD exacerbation) (P = .02). No differences were found for postoperative complications of Clavien-Dindo score ≥ III, 30-day mortality, or 30-day readmissions. After the matching, no differences were found between the smokers and the non-smokers.
After a propensity-score match analysis, smoking did not appear to negatively affect the intra- and postoperative outcomes after robotic liver resections. We believe that the robotic approach as the most modern minimally invasive technique in liver resection may have the potential to mitigate the known adverse effects of smoking.
吸烟对患者健康和术后发病率的有害影响已有充分记录。然而，关于吸烟史对机器人手术（特别是机器人肝切除术）影响的文献却很少。本研究旨在确定吸烟史是否会影响接受机器人肝切除术的患者的术后病程。
我们前瞻性地随访了 353 例接受机器人肝切除术的患者。125 例患者有适当的吸烟史（即吸烟者），228 例患者被归类为非吸烟者。数据以中位数（均值±标准差）表示。然后根据患者和肿瘤特征对患者进行倾向评分匹配。
在匹配之前，与不吸烟者相比，吸烟者的 MELD 评分和肝硬化状态显著更高（平均 MELD 评分分别为 9 分和 8 分，肝硬化分别为 25%和 13%的患者）。吸烟者和非吸烟者的 BMI、既往腹部手术次数、ASA 身体状况分类和 Child-Pugh 评分相似。6%的吸烟者比 1%的非吸烟者出现肺部并发症（肺炎、气胸和 COPD 恶化）（P =.02）。两组在 Clavien-Dindo 评分≥III 级的术后并发症、30 天死亡率或 30 天再入院率方面无差异。匹配后，吸烟者和非吸烟者之间无差异。
经过倾向评分匹配分析，吸烟似乎不会对机器人肝切除术后的围手术期结果产生负面影响。我们认为，机器人手术作为肝脏切除中最现代的微创技术，可能具有减轻已知吸烟不良影响的潜力。
