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Purpose <p>To 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).</p> Methods <p>This retrospective cohort study analyzed 521 ESCC patients from two centers (2020–2023), categorized by preoperative cessation duration: Long-term (≥ 12 months, <i>n</i> = 182), medium-term (3–12 months, <i>n</i> = 125), Short-term (&lt; 3 months, <i>n</i> = 124), and Continued smoking (mandated 2 weeks pre-op cessation, <i>n</i> = 90). Primary outcomes were Clavien-Dindo graded complications and overall survival (OS), analyzed using multivariable regression adjusted for confounders.</p> Results <p>Compared to the Long-term cessation group, both Short-term cessation (OR = 1.76, 95%CI:1.01–3.09, <i>P</i> = 0.049) and Continued smoking status (OR = 3.07, 95%CI:1.70–5.52, <i>P</i> &lt; 0.001) were independent risk factors for postoperative complications, with significantly higher rates of anastomotic leak (16.13% and 24.44% vs. 8.79%, <i>P</i> = 0.002) and pneumonia (38.71% and 43.33% vs. 19.23%, <i>P</i> &lt; 0.001), as well as severe (Clavien-Dindo III-V) complications (27.42% and 40.00% vs. 16.48%, <i>P</i> &lt; 0.001). Survival analysis revealed a significant inverse gradient; Intermediate cessation (HR = 1.67, 95%CI:1.07–2.60, <i>P</i> = 0.025), Short-term cessation (HR = 1.72, 95%CI:1.13–2.63, <i>P</i> = 0.012), and Continued smoking (HR = 1.77, 95%CI:1.14–2.75, <i>P</i> = 0.011) were all independently associated with increased mortality risk relative to Long-term cessation.</p> Conclusion <p>Preoperative 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.</p>

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Inadequate preoperative smoking cessation fails to improve outcomes after esophagectomy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月20日

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  • Jun-Xiong Xu,
  • Mei-Hua Wu,
  • Jin-Lian Chen,
  • Jiang-Shan Huang,
  • Yi-Xi Liang

摘要

Purpose

To 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).

Methods

This 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.

Results

Compared 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.

Conclusion

Preoperative 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.