Answer:

Cigarette smoking remains the leading cause of lung cancer in the United States. Tobacco exposure is linked to chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema, and is strongly associated with an increased incidence of stroke, myocardial infarction, and cancer (lung, oral cavity, larynx, and esophagus). Pulmonary hypertension from chronic hypoxemia and subsequent cor pulmonale may also occur.

Eight percent to 17% of patients with lung cancer who are scheduled for surgical resection are still smoking at the time of surgery. Current tobacco use increases the risk of postoperative respiratory failure, pneumonia, aspiration, air leak, and atelectasis as well as 1-year mortality. Preoperative smoking cessation is strongly recommended, but it is unclear how long is needed before surgery to see a significant reduction in postoperative complications. Carboxyhemoglobin concentrations decline substantially within 12 hours of smoking cessation. Four weeks of abstinence decrease the incidence of postoperative respiratory complications, probably because of an improved mucociliary function. However, because continuous local tumor growth and metastatic spread may preclude resectability, a prolonged period of preoperative abstinence may not be practical. Nonetheless, smoking cessation at any time prior to surgery is still strongly recommended. A combined approach including counseling and polypharmacology has been shown to increase the success rate and decrease relapses after hospital discharge.

• Lugg ST, Tikka T, Agostini PJ, et al. Smoking and timing of cessation on postoperative pulmonary complications after curative-intent lung cancer surgery. J Cardiothorac Surg. 2017;12:52.
• Turan A, Koyuncu O, Egan C, et al. Effect of various durations of smoking cessation on postoperative outcomes: a retrospective cohort analysis. Eur J Anaesthesiol. 2018;35:256-265.