Tobacco Smoking Associated With Increased Anastomotic Disruption Following Pancreaticoduodenectomy.
Adult
Aged
Aged, 80 and over
Anastomosis, Surgical
/ adverse effects
Anastomotic Leak
/ epidemiology
Carcinoma, Pancreatic Ductal
/ etiology
Female
Humans
Male
Middle Aged
Pancreatic Fistula
/ epidemiology
Pancreatic Neoplasms
/ etiology
Pancreaticoduodenectomy
/ adverse effects
Prognosis
Retrospective Studies
Risk Assessment
Risk Factors
Sex Factors
Tobacco Smoking
/ adverse effects
Treatment Outcome
Complications
Pancreas cancer
Pancreatic fistula
Pancreaticoduodenectomy
Smoking
Tobacco
Journal
The Journal of surgical research
ISSN: 1095-8673
Titre abrégé: J Surg Res
Pays: United States
ID NLM: 0376340
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
03
03
2018
revised:
19
06
2018
accepted:
13
07
2018
entrez:
4
12
2018
pubmed:
7
12
2018
medline:
14
11
2019
Statut:
ppublish
Résumé
The effect of cigarette smoking on postoperative morbidity following pancreaticoduodenectomy (PD) for cancer is unclear. We hypothesize that smoking is associated with higher morbidity following PD. A retrospective review of patients undergoing PD for cancer from 2010 to 2016 at a single institution was performed. Patients who had never smoked were compared to current or past-smokers with at least 1 pack-year history. Univariate and multivariable analyses were performed. Two hundred fifty-two patients met inclusion criteria. On univariate analysis, there was a significant difference between smokers and never-smokers in age at diagnosis (65.5 versus 68.6 y, P = 0.013) and fistula rate (28.5% versus 16.2%, P = 0.024). Male sex was significantly associated with fistula rate compared with female sex (15.5% versus 7.1%, P = 0.023). Comparing males and females separately, smoking correlated with higher fistula development only in the male cohort (22.5% versus 5.8%, P = 0.016 in men and 7.3% versus 9.1%, P = 1.00 in women). On multivariable analysis, current and past smoking was independently predictive of developing a fistula: odds ratio of 2.038 (P = 0.030). For current and past-smokers, male sex was an independent risk factor for developing a fistula: odds ratio 2.817 (P = 0.022). There were no other significant differences between groups in rates of postoperative complications. Smoking status is independently predictive of postoperative pancreatic fistula following PD for cancer. Among smokers, male sex is an independent risk factor for fistula. Further studies are needed to determine if smoking cessation before surgery decreases this risk, and if so, the optimal duration of cessation.
Sections du résumé
BACKGROUND
The effect of cigarette smoking on postoperative morbidity following pancreaticoduodenectomy (PD) for cancer is unclear. We hypothesize that smoking is associated with higher morbidity following PD.
METHODS
A retrospective review of patients undergoing PD for cancer from 2010 to 2016 at a single institution was performed. Patients who had never smoked were compared to current or past-smokers with at least 1 pack-year history. Univariate and multivariable analyses were performed.
RESULTS
Two hundred fifty-two patients met inclusion criteria. On univariate analysis, there was a significant difference between smokers and never-smokers in age at diagnosis (65.5 versus 68.6 y, P = 0.013) and fistula rate (28.5% versus 16.2%, P = 0.024). Male sex was significantly associated with fistula rate compared with female sex (15.5% versus 7.1%, P = 0.023). Comparing males and females separately, smoking correlated with higher fistula development only in the male cohort (22.5% versus 5.8%, P = 0.016 in men and 7.3% versus 9.1%, P = 1.00 in women). On multivariable analysis, current and past smoking was independently predictive of developing a fistula: odds ratio of 2.038 (P = 0.030). For current and past-smokers, male sex was an independent risk factor for developing a fistula: odds ratio 2.817 (P = 0.022). There were no other significant differences between groups in rates of postoperative complications.
CONCLUSIONS
Smoking status is independently predictive of postoperative pancreatic fistula following PD for cancer. Among smokers, male sex is an independent risk factor for fistula. Further studies are needed to determine if smoking cessation before surgery decreases this risk, and if so, the optimal duration of cessation.
Identifiants
pubmed: 30502248
pii: S0022-4804(18)30528-6
doi: 10.1016/j.jss.2018.07.047
pmc: PMC6346734
mid: NIHMS1001745
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
199-206Subventions
Organisme : NCI NIH HHS
ID : T32 CA126607
Pays : United States
Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.
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