The limited protective effect of prolonged smoking cessation on postoperative outcomes in uniportal video-assisted thoracic surgery for pulmonary nodules.

BACKGROUND

Cigarette smoking significantly increases both lung cancer risk and postoperative pulmonary complications. While smoking cessation before surgery is recommended, the optimal duration remains controversial, particularly for uniportal video-assisted thoracoscopic surgery (VATS). This study aimed to clarify the relationship between smoking cessation duration and postoperative outcomes following uniportal VATS for pulmonary nodules.

METHODS

This retrospective observational study examined the relationship between smoking cessation duration and complications in patients receiving uniportal VATS for solitary pulmonary nodules. The cohort included patients treated from January to December 2024. Smokers were divided into short-term (≤4 weeks) and long-term quitters (>4 weeks) based on preoperative cessation period.

RESULTS

Among 473 patients, 92 (19.5 %) experienced complications. No significant differences were found between short-term and long-term quitters in overall complications (20.4 % vs 17.3 %, p = 0.428) or pulmonary complications (19.5 % vs 17.3 %, p = 0.574). Postoperative day 1 assessments showed comparable pulmonary function and 6-MWD between groups. However, long-term quitters reported significantly reduced cough intensity (1.2 ± 0.4 vs 2.1 ± 0.5, p = 0.028), with no differences in sputum characteristics or volume.

CONCLUSION

In the context of uniportal VATS for solitary pulmonary nodules, our findings indicate that preoperative smoking cessation exceeding four weeks provides limited additional protection against early postoperative dysfunction. Clinical decision-making should balance this evidence against individual oncologic urgency. For patients with solitary lung nodules requiring uniportal VATS, postponing surgery to accommodate a smoking cessation period seemed unnecessary.