Skip to main content

Advertisement

SpringerLink
Log in

Preoperative Smoking Cessation and Prognosis After Curative Esophagectomy for Esophageal Cancer: A Cross-Sectional Study

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Several cohort studies have reported that post-esophagectomy morbidities may worsen prognosis. Smoking cessation is an effective prophylactic measure for reducing post-esophagectomy morbidity; however, whether smoking cessation can contribute to the improvement of prognosis is unknown due to the absence of reliable databases covering the cessation period. This study aimed to elucidate whether sufficient preoperative smoking cessation can improve prognosis after esophageal cancer surgery by reducing post-esophagectomy morbidity.

Methods

This study included 544 consecutive patients who underwent curative McKeown and Ivor–Lewis esophagectomies for esophageal cancer between May 2011 and June 2021. Data on smoking status and cessation period were prospectively accumulated. Survival data were finally updated on 30 January 2022. Receiver operating characteristic curve analysis for the cut-off value of appropriate cessation period in reducing post-esophagectomy respiratory morbidity as well as analyses for the association of cessation period with short- and long-term outcomes were performed.

Results

Post-esophagectomy morbidity significantly diminished overall survival (OS) after esophagectomy (p = 0.0003). A short preoperative smoking cessation period of ≤ 2 months was associated with frequent post-esophagectomy morbidity of Clavien–Dindo classification ≥IIIb (p = 0.0059), pneumonia (p = 0.016), respiratory morbidity (p = 0.0057), and poor OS in clinical stages II and III (p = 0.0015). Moreover, it was an independent factor for poor OS (hazard ratio 1.85, 95% confidence interval 1.068–3.197; p = 0.028), along with body mass index <18.5 and R1 resection.

Conclusions

Sufficient preoperative smoking cessation > 2 months may be effective in improving not only short-term outcomes but also prognosis after esophagectomy for locally advanced esophageal cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Yoshida N, Yamamoto H, Baba H, et al. Can minimally invasive esophagectomy replace open esophagectomy for esophageal cancer? Latest analysis of 24,233 esophagectomies from the Japanese national clinical database. Ann Surg. 2020;272:118–24.

    Article  PubMed  Google Scholar 

  2. Yoshida N, Kosumi K, Tokunaga R, et al. Clinical importance of mean corpuscular volume as a prognostic marker after esophagectomy for esophageal cancer: a retrospective study. Ann Surg. 2020;271:494–501.

    Article  PubMed  Google Scholar 

  3. Baba Y, Yoshida N, Shigaki H, et al. Prognostic impact of postoperative complications in 502 patients with surgically resected esophageal squamous cell carcinoma: a retrospective single-institution study. Ann Surg. 2016;264:305–11.

    Article  PubMed  Google Scholar 

  4. Yoshida N, Baba Y, Hiyoshi Y, et al. Duration of smoking cessation and postoperative morbidity after esophagectomy for esophageal cancer: how long should patients stop smoking before surgery? World J Surg. 2016;40:142–7.

    Article  PubMed  Google Scholar 

  5. Kamarajah SK, Madhavan A, Chmelo J, et al. Impact of smoking status on perioperative morbidity, mortality, and long-term survival following transthoracic esophagectomy for esophageal cancer. Ann Surg Oncol. 2021;28:4905–15.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Rice TW, Ishwaran H, Ferguson MK, Blackstone EH, Goldstraw P. Cancer of the esophagus and esophagogastric junction: an eighth edition staging primer. J Thorac Oncol. 2017;12:36–42.

    Article  PubMed  Google Scholar 

  7. Kuwano H, Nishimura Y, Oyama T, et al. Guidelines for diagnosis and treatment of carcinoma of the esophagus April 2012 edited by the Japan Esophageal Society. Esophagus. 2015;12:1–30.

    Article  PubMed  Google Scholar 

  8. Yoshida N, Baba Y, Shigaki H, et al. Preoperative nutritional assessment by controlling nutritional status (CONUT) is useful to estimate postoperative morbidity after esophagectomy for esophageal cancer. World J Surg. 2016;40:1910–7.

    Article  PubMed  Google Scholar 

  9. Yoshida N, Nakamura K, Kuroda D, et al. Preoperative Smoking Cessation is integral to the prevention of postoperative morbidities in minimally invasive esophagectomy. World J Surg. 2018;42:2902–9.

    Article  PubMed  Google Scholar 

  10. Mazaki T, Ishii Y, Murai I. Immunoenhancing enteral and parenteral nutrition for gastrointestinal surgery: a multiple-treatments meta-analysis. Ann Surg. 2015;261:662–9.

    Article  PubMed  Google Scholar 

  11. Yamana I, Takeno S, Hashimoto T, et al. Randomized controlled study to evaluate the efficacy of a preoperative respiratory rehabilitation program to prevent postoperative pulmonary complications after esophagectomy. Dig Surg. 2015;32:331–7.

    Article  PubMed  Google Scholar 

  12. Akutsu Y, Matsubara H, Shuto K, et al. Pre-operative dental brushing can reduce the risk of postoperative pneumonia in esophageal cancer patients. Surgery. 2010;147:497–502.

    Article  PubMed  Google Scholar 

  13. Tsujimoto H, Kobayashi M, Sugasawa H, Ono S, Kishi Y, Ueno H. Potential mechanisms of tumor progression associated with postoperative infectious complications. Cancer Metastasis Rev. 2021;40:285–96.

    Article  PubMed  Google Scholar 

  14. Kauppila JH, Johar A, Lagergren P. Postoperative complications and health-related quality of life 10 years after esophageal cancer surgery. Ann Surg. 2020;271:311–6.

    Article  PubMed  Google Scholar 

  15. Watanabe M, Ishimoto T, Baba Y, et al. Prognostic impact of body mass index in patients with squamous cell carcinoma of the esophagus. Ann Surg Oncol. 2013;20:3984–91.

    Article  PubMed  Google Scholar 

  16. Yoshida N, Harada K, Baba Y, et al. Preoperative controlling nutritional status (CONUT) is useful to estimate the prognosis after esophagectomy for esophageal cancer. Langenbecks Arch Surg. 2017;402:333–41.

    Article  PubMed  Google Scholar 

  17. Klevebro F, Elliott JA, Slaman A, et al. Cardiorespiratory comorbidity and postoperative complications following esophagectomy: a European Multicenter Cohort Study. Ann Surg Oncol. 2019;26:2864–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366:2074–84.

    Article  PubMed  Google Scholar 

  19. Ando N, Kato H, Igaki H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19:68–74.

    Article  PubMed  Google Scholar 

  20. Demarest CT, Chang AC. The landmark series: multimodal therapy for esophageal cancer. Ann Surg Oncol. 2021;28:3375–82.

    Article  PubMed  Google Scholar 

  21. Yoshida N, Baba Y, Kuroda D, et al. Clinical utility of exhaled carbon monoxide in assessing preoperative smoking status and risks of postoperative morbidity after esophagectomy. Dis Esophagus. 2018; 31.

  22. Triantafyllou T, Olson MT, Theodorou D, Schizas D, Singhal S. Enhanced recovery pathways vs standard care pathways in esophageal cancer surgery: systematic review and meta-analysis. Esophagus. 2020;17:100–12.

    Article  PubMed  Google Scholar 

  23. Kawata S, Hiramatsu Y, Shirai Y, et al. Multidisciplinary team management for prevention of pneumonia and long-term weight loss after esophagectomy: a single-center retrospective study. Esophagus. 2020;17:270–8.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Watanabe M, Mine S, Nishida K, et al. Improvement in short-term outcomes after esophagectomy with a multidisciplinary perioperative care team. Esophagus. 2016;13:337–42.

    Article  Google Scholar 

  25. Chen Z, Huang K, Wei R, et al. Transcervical inflatable mediastinoscopic esophagectomy versus thoracoscopic esophagectomy for local early- and intermediate-stage esophageal squamous cell carcinoma: a propensity score-matched analysis. J Surg Oncol. 2022;125:839–46.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Mederos MA, de Virgilio MJ, Shenoy R, et al. Comparison of clinical outcomes of robot-assisted, video-assisted, and open esophagectomy for esophageal cancer: a systematic review and meta-analysis. JAMA Netw Open. 2021;4:e2129228.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

None.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, 860-8556, Japan

    Naoya Yoshida MD, PhD, Kojiro Eto MD, PhD, Tomo Horinouchi MD, Kazuto Harada MD, PhD, Hiroshi Sawayama MD, PhD, Katsuhiro Ogawa MD, PhD, Yohei Nagai MD, PhD, Masaaki Iwatsuki MD, PhD, Shiro Iwagami MD, PhD, Takatsugu Ishimoto MD, PhD, Yoshifumi Baba MD, PhD, Yuji Miyamoto MD, PhD & Hideo Baba MD, PhD

  2. Division of Translational Research and Advanced Treatment Against Gastrointestinal Cancer, Kumamoto University, Chuoku, Kumamoto, 860-8556, Japan

    Naoya Yoshida MD, PhD & Takatsugu Ishimoto MD, PhD

Authors
  1. Naoya Yoshida MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kojiro Eto MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tomo Horinouchi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kazuto Harada MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hiroshi Sawayama MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Katsuhiro Ogawa MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yohei Nagai MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Masaaki Iwatsuki MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shiro Iwagami MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Takatsugu Ishimoto MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yoshifumi Baba MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Yuji Miyamoto MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Hideo Baba MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hideo Baba MD, PhD.

Ethics declarations

Disclosure

Naoya Yoshida and Takatsugu Ishimoto are members of the department supported by Chugai Pharmaceutical Co., Ltd and Yakuruto Honsya Co., Ltd, but have no conflicts of interest regarding this research. Yoshifumi Baba is a member of the department supported by Taiho Pharmaceutical Co., Ltd, but has no conflicts of interest regarding this research. Hideo Baba, Kojiro Eto, Tomo Horinouchi, Kazuto Harada, Hiroshi Sawayama, Katsuhiro Ogawa, Yohei Nagai, Masaaki Iwatsuki, Shiro Iwagami, and Yuji Miyamoto have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file 1. (DOCX 16 kb)

10434_2022_12433_MOESM2_ESM.pptx

Supplementary file 2. Fig. S1 Kaplan–Meier curves of overall survival between smokers and non-smokers in (a) all patients, (b) clinical stage IB, (c) clinical stage II and III, and (d) clinical stage IVA

10434_2022_12433_MOESM3_ESM.pptx

Supplementary file 3. Fig. S2 Kaplan–Meier curves of overall survival in clinical stage I in accordance with the appropriate duration of smoking cessation calculated by the Youden index

10434_2022_12433_MOESM4_ESM.pptx

Supplementary file 4. Fig. S3 Kaplan–Meier curves of overall survival in clinical stage IVa in accordance with the appropriate duration of smoking cessation calculated by the Youden index

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yoshida, N., Eto, K., Horinouchi, T. et al. Preoperative Smoking Cessation and Prognosis After Curative Esophagectomy for Esophageal Cancer: A Cross-Sectional Study. Ann Surg Oncol 29, 8172–8180 (2022). https://doi.org/10.1245/s10434-022-12433-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-022-12433-z

Search

Navigation