Assessment of Duration of Smoking Cessation Prior to Surgical Treatment of Non-small Cell Lung Cancer.

OBJECTIVE To define the relationship between the duration of smoking cessation and post-operative complications for patients with lung cancer undergoing surgical treatment. BACKGROUND Smoking increases the risk of post-operative morbidity and mortality in patients with lung cancer undergoing surgical treatment. While smoking cessation before surgery can mitigate these risks, the ideal duration of pre-operative smoking cessation remains unclear. METHODS Using a uniquely compiled Veterans Health Administration (VHA) dataset, we performed a retrospective cohort study of patients with clinical stage I non-small cell lung cancer (NSCLC) undergoing surgical treatment between 2006 and 2016. We characterized the relationship between duration of pre-operative smoking cessation and risk of post-operative complications or mortality within 30-days using multivariable restricted cubic spline functions. RESULTS The study included a total of 9509 patients, of whom 6168 (64.9%) were smoking at the time of lung cancer diagnosis. Among them, only 662 (10.7%) patients stopped smoking prior to surgery. Longer duration between smoking cessation and surgery was associated with lower odds of major complication or mortality (aOR for every additional week, 0.919; 95% CI, 0.850-0.993; P = 0.03). Compared to non-smokers, patients who quit at least 3 weeks before surgery had similar odds of major complication (aOR, 1.005; 95% CI, 0.702-1.437; P = 0.98) whereas those who quit within 3 weeks of surgery had significantly higher odds of major complication (aOR, 1.698; 95% CI, 1.203-2.396; P = 0.003). CONCLUSION Smoking cessation at least 3 weeks prior to the surgical treatment of lung cancer is associated with reduced morbidity and mortality. Providers should aggressively encourage smoking cessation in the pre-operative period, since it can disproportionately impact outcomes in early-stage lung cancer.