COPD, smoking aggravate complication risk after lung cancer resection

Smoking and chronic obstructive pulmonary disease (COPD) worsen the risk of postoperative pulmonary complications (PPC) after lung cancer resection, a recent study has found. Focusing on COPD treatment, rather than smoking cessation alone, may be a more optimal approach to improve postoperative outcomes in this population.

Researchers conducted a retrospective review of 1,013 lung cancer patients (mean age 66 years, 61 percent men) who had received curative-intent lobectomy or pneumonectomy between 1995 and 2018. Thirty-six percent (n=362) of participants were ex-smokers, while 31 percent (n=314) were current smokers; a small percentage (11 percent; n=111) were never-smokers. Preoperative COPD was present in 57 percent, 57 percent, and 20 percent of the respective smoking subgroups.

Twenty-six percent of patients developed a PPC, with 71 patients experiencing more than one such complication. Common PPCs included air leak (12 percent), pneumonia (7 percent), sputum retention, atelectasis, and respiratory failure (4 percent each).

PPCs developed at a significantly higher frequency in those with COPD (65 percent vs 35 percent; adjusted odds ratio [OR], 1.76, 95 percent confidence interval [CI], 1.02–2.41; p<0.01). The same was true for the rate of overall complications (60 percent vs 40 percent; adjusted OR, 1.53, 95 percent CI, 1.17–2.01; p<0.01). Individual complications were likewise more common in those with COPD, as was average length of stay.

In comparison, PPCs were only more common in current smokers when comparing against never-smokers (27 percent vs 17 percent; p=0.036), but not against ex-smokers (p=0.412). The rate of overall complications did not differ according to smoking status.