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.

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.