ArticleJournal of cardiothoracic surgery2026
Inadequate preoperative smoking cessation fails to improve outcomes after esophagectomy.
Article in Journal of cardiothoracic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo quantify the impact of preoperative smoking cessation duration on postoperative complications and long-term survival in long-term smokers undergoing radical esophagectomy for esophageal squamous cell carcinoma (ESCC).
methodsThis retrospective cohort study analyzed 521 ESCC patients from two centers (2020–2023), categorized by preoperative cessation duration: Long-term (≥ 12 months, n = 182), medium-term (3–12 months, n = 125), Short-term (< 3 months, n = 124), and Continued smoking (mandated 2 weeks pre-op cessation, n = 90). Primary outcomes were Clavien-Dindo graded complications and overall survival (OS), analyzed using multivariable regression adjusted for confounders.
resultsCompared to the Long-term cessation group, both Short-term cessation (OR = 1.76, 95%CI:1.01–3.09, P = 0.049) and Continued smoking status (OR = 3.07, 95%CI:1.70–5.52, P < 0.001) were independent risk factors for postoperative complications, with significantly higher rates of anastomotic leak (16.13% and 24.44% vs. 8.79%, P = 0.002) and pneumonia (38.71% and 43.33% vs. 19.23%, P < 0.001), as well as severe (Clavien-Dindo III-V) complications (27.42% and 40.00% vs. 16.48%, P < 0.001). Survival analysis revealed a significant inverse gradient; Intermediate cessation (HR = 1.67, 95%CI:1.07–2.60, P = 0.025), Short-term cessation (HR = 1.72, 95%CI:1.13–2.63, P = 0.012), and Continued smoking (HR = 1.77, 95%CI:1.14–2.75, P = 0.011) were all independently associated with increased mortality risk relative to Long-term cessation.
conclusionPreoperative smoking cessation for at least 12 months is critical for optimizing outcomes after esophagectomy, as shorter durations (including 3–12 months) confer significantly higher risks of severe complications and mortality.
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