Smoking and Complications After Cancer Surgery: A Systematic Review and Meta-Analysis
Clement Wong1, Siti Khadijah Binti Mohamad Asfia2, Paul S Myles3
1Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia.
JAMA Network Open
|March 7, 2025
Summary
Stopping smoking for at least four weeks before cancer surgery significantly reduces the risk of postoperative complications. This finding is crucial for informing decisions about delaying surgery for patients who smoke.
Area of Science:
- Oncology
- Surgical Outcomes
- Public Health
Background:
- Surgical cancer treatments are often delayed for patients who smoke due to concerns about increased postoperative complications.
- Quantifying the risks associated with recent smoking is essential for balancing surgical timing and patient safety.
Purpose of the Study:
- To investigate the association between smoking status, smoking cessation duration, and the incidence of complications following cancer surgery.
Main Methods:
- Systematic literature search of Embase, CINAHL, Medline COMPLETE, and Cochrane Library (2000-2023).
- Inclusion of observational and interventional studies comparing complication rates in smokers versus non-smokers undergoing cancer surgery.
- Meta-analysis using a random-effects model, with data extracted following MOOSE guidelines.
Main Results:
- Smoking within 4 weeks preoperatively increased odds of complications compared to cessation for at least 4 weeks (OR 1.31) and never smoking (OR 2.83).
- No significant difference in complications was found for smoking within 2 weeks versus cessation between 2 weeks and 3 months (OR 1.19).
- Smoking within 1 year of surgery showed higher complication odds than cessation for at least 1 year (OR 1.13).
Conclusions:
- Cessation of smoking for at least 4 weeks prior to cancer surgery is associated with reduced postoperative complications.
- Further high-quality evidence is needed to determine the optimal smoking cessation period and guide clinical decisions on delaying surgery.
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