Researchers at the University of Cincinnati College of Medicine found that patients who continue to smoke before lung cancer surgery have an increased risk of pulmonary complications, but their short-term mortality rate is similar to that of patients who are able to quit before surgery.
Published in Journal of the American College of Surgeonsthe findings suggest that physicians are reconsidering traditional models that exclude certain patients who continue to smoke until the time of treatment after lung cancer surgery. Doctors traditionally want patients to quit smoking a month before surgery, but a more personalized plan may offer healthier options for patients.
Smoking is clearly very bad and is associated with the development of cancer and heart disease. And our study shows that it increases the chance of postoperative complications. ”
Robert Van Haren, MD, Research Scientist, University of Cincinnati Cancer Center, Associate Professor of Clinical Surgery, University of California School of Medicine
“We absolutely want our patients to quit smoking, and we want them to do so before surgery. But even if some patients are unable or unwilling to quit, we can still safely offer surgery to treat lung cancer,” added Van Haren, a UC Health surgeon and corresponding author of the study.
“There is no difference in the chance of death, so surgery may be able to save them, but decisions need to be made carefully and individually, rather than focusing on one factor,” Van Haren said.
Researchers at the University of California analyzed lung cancer resection results for 85,124 patients enrolled in the Society of Thoracic Surgeons’ General Thoracic Surgery Database from 2018 to 2023. They found that patients who currently smoked were younger and had fewer complications.
Pulmonary complications were more common in patients who were current smokers (34.6% vs. 30.5%), but mortality rates did not differ by smoking status, with mortality rates of 1% for both current smokers and those who quit before surgery.
Van Haren said the findings suggest an association rather than causation. He added that surgeons will consider several factors about the patient, including their age, whether they are walking or in a wheelchair, and whether cancer surgery can only be performed safely through an open heart surgery.
Traditionally, Van Hollen explains, the standard of treatment for many cancers has been for surgeons to remove larger sections of the lung. However, the increased use of robot-assisted surgery has changed treatment options.
“We perform many surgeries robotically through smaller incisions so that patients recover better and are less likely to develop problems such as pneumonia compared to open-heart surgery,” Van Haren said. “Changes in technology and knowledge have allowed us to offer surgery to more patients.”
The study’s lead author is Dr. Hannah Kim, a recent graduate of the University of California School of Medicine. Other co-authors from the University of California School of Medicine include cardiothoracic researcher Sophia Wagemaker Viana, MD; Christiana Pinkson, Research Fellow, School of Medicine; and Catherine Platt, a medical resident.
Additional co-authors include Dr. Shesh Rai, a member of the Cancer Center’s Experimental Therapeutics Research Program and director of the Cancer Center’s Biostatistics and Informatics Shared Resources. Sandra Starnes, MD, director of cardiothoracic surgery and cancer center member at the UC School of Medicine and UC Health; Christine Haugen, MD, Assistant Professor of Surgery, University of California Health Surgeons; Ralph Quillin III, MD, Assistant Professor of Surgery, University of California Health Department Surgeon;
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Reference magazines:
Kim, H. Others. (2026). Effect of smoking status on morbidity and mortality after lung cancer resection: Analysis of the Society of Thoracic Surgeons’ General Thoracic Surgery Database. Journal of the American College of Surgeons. DOI: 10.1097/xcs.0000000000002007. https://journals.lww.com/journalacs/abstract/9900/impact_of_smoking_status_on_morbidity_and.1784.aspx
