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Pre-op smoking cessation improves head and neck surgery outcomes

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Even a short period of 4 to 8 weeks of smoking cessation prior to surgery to treat upper aerodigestive tract squamous cell carcinoma improves wound healing, according to a review of the literature. If the patient stays tobacco-free, the risk of cancer recurrence is substantially reduced.

However, full cessation is required — simply reducing the quantity of cigarettes smoked per day is of little benefit, Dr. Richard O. Wein from Tufts Medical Center, Boston, reports in the June Archives of Otolaryngology—Head and Neck Surgery.

Studies within the field of otolaryngology of the impact of smoking cessation on surgical outcomes are few and contradictory, Dr. Wein points out. For his review, he drew on studies of smokers operated on for non-otolaryngology conditions as well as for head and neck tumors.

The “bottom line,” he says, is that “although conflicting reports exist within the literature concerning the impact of short-term smoking cessation, it should be noted that the sheer number of articles reporting the negative impact of continued tobacco use on postoperative pulmonary function and wound healing far outweighs those minimizing this impact.”

Furthermore, multiple studies indicate increased risk of recurrence or the development of a second cancer in patients who continue to smoke after their index cancers are diagnosed. One study, for example, found that 40% of patients who kept smoking after being treated definitively for a malignant oral cavity tumor had a recurrence or developed a second malignant lesion.

Overall costs of care, the author notes, are considerable compared with those of individuals with an adequate period of preoperative cessation.

Unfortunately, patients with a diagnosis of a head and neck cancer usually don’t have the luxury of taking 2 months to stop smoking before surgery is imperative, Dr. Wein notes.

“In these scenarios,” he concludes, “although the impact of short-term (less than 2 weeks) preoperative smoking cessation on the immediate post-operative course may be modest, the long-term cardiopulmonary benefits and the potential decrease in the development of future smoking-related neoplasia with sustained cessation are undeniable.”

Reference:
Arch Otolaryngol Head Neck Surg 2009;135:597-601.