Surgical outcomes of smoking and nonsmoking women with lung adenocarcinoma.

BACKGROUND: Lung cancer is the leading cause of cancer-related death in the United States. Although smoking remains the largest risk factor for lung cancer development, there is a growing number of lung cancer cases among women without a smoking history. It is well known that smoking increases the morbidity of patients after thoracic surgery. However, the outcome of this specific patient population has not been well investigated. This study compares the short-term outcome of smoking and nonsmoking women after their surgical lung resection.

METHODS: We conducted a retrospective chart review of patients who were treated for lung cancer through surgical resection at the Long Island Jewish Medical Center between 2017 and 2024. Patients were included if they were women over the age of 18 years who were diagnosed with lung adenocarcinoma. A total of 385 patients were analyzed; their demographics, comorbidities, treatment, and follow-up course were recorded. All statistical analyses were conducted through SAS software.

RESULTS: Our results revealed that smokers presented with significantly more preoperative comorbidities than nonsmokers, specifically coronary artery disease (CAD) (10% vs. 4%; P=0.008), asthma (15% vs. 7%; P=0.02), chronic obstructive pulmonary disease (COPD) (31% vs. 2%; P<0.001), and peripheral vascular disease (PVD) (4% vs. 1%; P<0.05). The American Society of Anesthesiologists (ASA) score 3 is observed more frequently among smokers than nonsmokers (73% vs. 50%; P<0.001). The average body mass index was significantly greater for the smokers than the nonsmokers (P=0.03). Nearly all patients underwent minimally invasive surgery (MIS) (99% vs. 100%). Postoperative complications were observed in 15 (7.5%) nonsmokers and in 29 (16%) smokers (P=0.003). Subset analysis revealed that of the 19 different postoperative complications, atelectasis requiring bronchoscopy, had a significant difference between the groups (P=0.02). There was no difference between the median length of stay between the groups (3 days).

CONCLUSIONS: Our results suggest that women with a history of tobacco use present with significantly more preoperative comorbidities and postoperative complications than women without a smoking history. Subset analysis revealed that the only postoperative complication that had a significant difference was atelectasis. These results suggest that in the era of MIS, and with proper postoperative care, thoracic surgery is safe for smokers.