Esophagus : official journal of the Japan Esophageal Society · 2026
Association between preoperative heat-not-burn cigarette smoking and short-term outcomes after esophagectomy: a nationwide cohort study of 17,797 patients from the Japanese National Clinical Database.
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Kobayashi Shinichiro, Endo Hideki, Yamamoto Hiroyuki, Kanetaka Kengo, Kakeji Yoshihiro, Kimura Yasue, Saeki Hiroshi, Watanabe Masayuki, Hasegawa Hiroshi, Naitoh Takeshi, Doki Yuichiro, Kitagawa Yuko, Takeuchi Hiroya, Shirabe Ken
Аннотация
BACKGROUND: Heat-not-burn cigarettes (HNBCs) are marketed as reduced-risk combustible cigarette alternatives. However, their impact on surgical outcomes after invasive procedures, including esophagectomy, remains unclear. To evaluate the association between preoperative HNBC use and short-term outcomes after oncological esophagectomy.
METHODS: This retrospective cohort study utilized Japanese National Clinical Database data from patients who underwent esophagectomy for thoracic esophageal cancer between January 2019 and December 2021. The exposure was self-reported HNBC use within 1 year before surgery. The primary outcome was operative mortality. Secondary outcomes included life-threatening complications (Clavien-Dindo classification ≥ IV), anastomotic leakage, postoperative pneumonia, surgical site infection, and prolonged mechanical ventilation (≥ 48 h). Associations between HNBC use and outcomes were assessed using multilevel logistic regression models, adjusting for patient demographics, comorbidities, combustible cigarette smoking history, alcohol use, and tumor characteristics.
RESULTS: Of 17,797 patients, 589 (3.3%) reported preoperative HNBC use. HNBC users were younger and male, with higher rates of concurrent combustible cigarette use (85.2% vs. 33.2%), intense smoking history (Brinkman index ≥ 600:67.2% vs. 47.9%), and habitual alcohol consumption (80.5% vs. 66.6%) than non-users. After adjusting for confounders, HNBC use was associated with nonsignificant trends toward increased operative mortality [adjusted odds ratio (aOR): 1.82, 95% confidence interval (CI): 0.95-3.48; P = 0.07] and life-threatening complications (aOR: 1.56, 95% CI: 0.98-2.48; P = 0.06). No other secondary outcomes were significantly associated with HNBC use.
CONCLUSIONS: The observed trends, although nonsignificant, suggest that preoperative HNBC use may be associated with increased risks of operative mortality and life-threatening complications, warranting further investigation.
METHODS: This retrospective cohort study utilized Japanese National Clinical Database data from patients who underwent esophagectomy for thoracic esophageal cancer between January 2019 and December 2021. The exposure was self-reported HNBC use within 1 year before surgery. The primary outcome was operative mortality. Secondary outcomes included life-threatening complications (Clavien-Dindo classification ≥ IV), anastomotic leakage, postoperative pneumonia, surgical site infection, and prolonged mechanical ventilation (≥ 48 h). Associations between HNBC use and outcomes were assessed using multilevel logistic regression models, adjusting for patient demographics, comorbidities, combustible cigarette smoking history, alcohol use, and tumor characteristics.
RESULTS: Of 17,797 patients, 589 (3.3%) reported preoperative HNBC use. HNBC users were younger and male, with higher rates of concurrent combustible cigarette use (85.2% vs. 33.2%), intense smoking history (Brinkman index ≥ 600:67.2% vs. 47.9%), and habitual alcohol consumption (80.5% vs. 66.6%) than non-users. After adjusting for confounders, HNBC use was associated with nonsignificant trends toward increased operative mortality [adjusted odds ratio (aOR): 1.82, 95% confidence interval (CI): 0.95-3.48; P = 0.07] and life-threatening complications (aOR: 1.56, 95% CI: 0.98-2.48; P = 0.06). No other secondary outcomes were significantly associated with HNBC use.
CONCLUSIONS: The observed trends, although nonsignificant, suggest that preoperative HNBC use may be associated with increased risks of operative mortality and life-threatening complications, warranting further investigation.