Subscribe to RSS
DOI: 10.1055/s-0031-1273258
© Georg Thieme Verlag KG Stuttgart · New York
Präoperative Tabakentwöhnung bei Patienten mit Bronchialkarzinom[*]
Preoperative Smoking Cessation in Patients with Lung CancerPublication History
eingereicht: 3.5.2010
angenommen: 18.5.2010
Publication Date:
07 April 2011 (online)
![](https://www.thieme-connect.de/media/tumor/201102/lookinside/thumbnails/10.1055-s-0031-1273258-1.jpg)
Zusammenfassung
Eine erfolgreiche Tabakentwöhnung verbessert bei Patienten mit Bronchialkarzinom die Prognose quoad vitam. Dennoch wird Rauchern mit einem nicht-kleinzelligen Bronchialkarzinom und geplanter kurativer Resektion häufig davon abgeraten, das Rauchen in der unmittelbaren präoperativen Phase einzustellen. Diese Empfehlung stützt sich auf eine prospektive Kohortenstudie aus dem Jahre 1998, in der eine Reduktion des Tabakkonsums in den letzten acht Wochen vor einem nicht-thorakalen Eingriff mit einer Erhöhung des Risikos für perioperative pulmonale Komplikationen einherging. Zwar wurden in den vergangenen 12 Jahren zahlreiche weitere Beobachtungsstudien zu den Auswirkungen einer präoperativen Entwöhnung auf das perioperative Risiko bei thorakalen und nicht-thorakalen Operationen publiziert – nur sechs dieser Arbeiten bezogen sich jedoch auf Patienten mit Lungentumoren. Aufgrund methodischer Schwächen und der großen Heterogenität der untersuchten Patientengruppen lässt sich aus den vorliegenden Daten keine Empfehlung für oder gegen einen Rauchstop in der unmittelbaren präoperativen Phase ableiten. Unter Berücksichtigung der für perioperative Komplikationen relevanten pathophysiologischen Prozesse und des zeitlichen Verlaufs ihrer Erholung nach einer Tabakentwöhnung erscheint eine mindestens zwei- bis sechswöchige präoperative Rauchkarenz sinnvoll; im Kontext der meist dringlichen Indikation zur kurativen Resektion erscheint dies zuweilen unrealistisch. Da aber auch kürzere präoperative Abstinenzphasen die Prognose nicht nachweislich verschlechtern, sollten Patienten mit Bronchialkarzinom eine Empfehlung zur präoperativen Tabakentwöhnung erhalten.
Abstract
Successful smoking cessation is associated with a survival benefit for patients with lung cancer. However, smokers newly diagnosed with non-small cell lung cancer and scheduled for curative resection are frequently discouraged from stopping smoking in the immediate preoperative period. This recommendation is based on the results of one single prospective cohort study published in 1998 which reported an increased risk of perioperative pulmonary complications in patients undergoing non-thoracic surgery who had reduced their tobacco consumption within the two months leading up to the operation. During the past 12 years, numerous observational studies have investigated the impact of preoperative smoking cessation on perioperative risk for thoracic and non-thoracic surgery. However, no more than six studies included patients with pulmonary neoplasms. Owing to methodological limitations and considerable heterogeneity of the included patient groups, the existing data are insufficient to support or refuse any recommendation regarding cessation advice for patients during the immediate preoperative phase. In view of the post-cessation recovery time-course of pathophysiological alterations relevant to the occurrence of perioperative complications, a smoke-free preoperative interval of 2 – 6 weeks appears most favourable. However, this is difficult to achieve as a curative resection should not be postponed. Since there is no scientific evidence demonstrating a negative impact of preoperative smoking cessation on prognosis, patients newly diagnosed with lung cancer should be encouraged to make an attempt to quit while waiting for thoracic surgery.
1 Diese Übersichtsarbeit wurde in ihren Grundzügen auf dem 51. Kongress der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e. V. im Rahmen eines Symposiums vorgestellt.
Literatur
- 1 Goeckenjan G, Sitter H, Thomas M. et al . Prävention, Diagnostik, Therapie und Nachsorge des Lungenkarzinoms. Interdisziplinäre S3-Leitlinie der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin und der Deutschen Krebsgesellschaft. Pneumologie. 2010; 64 Suppl 2 e1-e164
- 2 Simonato L, Agudo A, Ahrens W. et al . Lung cancer and cigarette smoking in Europe: an update of risk estimates and an assessment of inter-country heterogeneity. Int J Cancer. 2001; 91 876-887
- 3 Tobacco or health in the European Union – past, present and future. Prepared by the ASPECT Consortium. 2004, Luxemburg: Office for Official Publication of the European Communities. 25-68
- 4 Bryant A, Cerfolio R J. Differences in epidemiology, histology, and survival between cigarette smokers and never-smokers who develop non-small cell lung cancer. Chest. 2007; 132 185-192
- 5 Richardson G E, Tucker M A, Venzon D J. et al . Smoking cessation after successful treatment of small-cell lung cancer is associated with fewer smoking-related second primary cancers. Ann Intern Med. 1993; 119 383-390
- 6 Parsons A, Daley A, Begh R. et al . Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: systematic review of observational studies with meta-analysis. Bmj. 2010; 340 b5569
- 7 Fox J L, Rosenzweig K E, Ostroff J S. The effect of smoking status on survival following radiation therapy for non-small cell lung cancer. Lung Cancer. 2004; 44 287-293
- 8 Videtic G M, Stitt L W, Dar A R. et al . Continued cigarette smoking by patients receiving concurrent chemoradiotherapy for limited-stage small-cell lung cancer is associated with decreased survival. J Clin Oncol. 2003; 21 1544-1549
- 9 Wightman J A. A prospective survey of the incidence of postoperative pulmonary complications. Br J Surg. 1968; 55 85-91
- 10 Fielding L P, Phillips R K, Hittinger R. Factors influencing mortality after curative resection for large bowel cancer in elderly patients. Lancet. 1989; 1 595-597
- 11 Vaporciyan A A, Merriman K W, Ece F. et al . Incidence of major pulmonary morbidity after pneumonectomy: association with timing of smoking cessation. Ann Thorac Surg. 2002; 73 420-425; discussion 425 – 426
- 12 Bluman L G, Mosca L, Newman N. et al . Preoperative smoking habits and postoperative pulmonary complications. Chest. 1998; 113 883-889
- 13 Nakagawa M, Tanaka H, Tsukuma H. et al . Relationship between the duration of the preoperative smoke-free period and the incidence of postoperative pulmonary complications after pulmonary surgery. Chest. 2001; 120 705-710
- 14 Mitchell C K, Smoger S H, Pfeifer M P. et al . Multivariate analysis of factors associated with postoperative pulmonary complications following general elective surgery. Arch Surg. 1998; 133 194-198
- 15 Schwilk B, Bothner U, Schraag S. et al . Perioperative respiratory events in smokers and nonsmokers undergoing general anaesthesia. Acta Anaesthesiol Scand. 1997; 41 348-355
- 16 Moller A M, Maaloe R, Pedersen T. Postoperative intensive care admittance: the role of tobacco smoking. Acta Anaesthesiol Scand. 2001; 45 345-348
- 17 Moller A M, Pedersen T, Villebro N. et al . Effect of smoking on early complications after elective orthopaedic surgery. J Bone Joint Surg Br. 2003; 85 178-181
- 18 Myles P S, Iacono G A, Hunt J O. et al . Risk of respiratory complications and wound infection in patients undergoing ambulatory surgery: smokers versus nonsmokers. Anesthesiology. 2002; 97 842-847
- 19 Harpole Jr. D H, DeCamp Jr. M M, Daley J. et al . Prognostic models of thirty-day mortality and morbidity after major pulmonary resection. J Thorac Cardiovasc Surg. 1999; 117 969-979
- 20 Moller A M, Villebro N, Pedersen T. et al . Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet. 2002; 359 114-117
- 21 Lindstrom D, Sadr Azodi O, Wladis A. et al . Effects of a perioperative smoking cessation intervention on postoperative complications: a randomized trial. Ann Surg. 2008; 248 739-745
- 22 Thomsen T, Tonnesen H, Moller A M. Effect of preoperative smoking cessation interventions on postoperative complications and smoking cessation. Br J Surg. 2009; 96 451-461
- 23 Barrera R, Shi W, Amar D. et al . Smoking and timing of cessation: impact on pulmonary complications after thoracotomy. Chest. 2005; 127 1977-1983
- 24 Sardari Nia P, Weyler J, Colpaert C. et al . Prognostic value of smoking status in operated non-small cell lung cancer. Lung Cancer. 2005; 47 351-359
- 25 Groth S S, Whitson B A, Kuskowski M A. et al . Impact of preoperative smoking status on postoperative complication rates and pulmonary function test results 1-year following pulmonary resection for non-small cell lung cancer. Lung Cancer. 2009; 64 352-357
- 26 Mason D P, Subramanian S, Nowicki E R. et al . Impact of smoking cessation before resection of lung cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database study. Ann Thorac Surg. 2009; 88 362-370; discussion 370 – 371
- 27 Warner D O. Perioperative abstinence from cigarettes: physiologic and clinical consequences. Anesthesiology. 2006; 104 356-367
- 28 Tonnesen H, Nielsen P R, Lauritzen J B. et al . Smoking and alcohol intervention before surgery: evidence for best practice. Br J Anaesth. 2009; 102 297-306
- 29 Moller A, Tonnesen H. Risk reduction: perioperative smoking intervention. Best Pract Res Clin Anaesthesiol. 2006; 20 237-248
- 30 Konrad F X, Schreiber T, Brecht-Kraus D. et al . Bronchial mucus transport in chronic smokers and nonsmokers during general anesthesia. J Clin Anesth. 1993; 5 375-380
- 31 Verra F, Escudier E, Lebargy F. et al . Ciliary abnormalities in bronchial epithelium of smokers, ex-smokers, and nonsmokers. Am J Respir Crit Care Med. 1995; 151 630-634
- 32 Yamashita S, Yamaguchi H, Sakaguchi M. et al . Effect of smoking on intraoperative sputum and postoperative pulmonary complication in minor surgical patients. Respir Med. 2004; 98 760-766
- 33 Honda Y, Takahashi H, Kuroki Y. et al . Decreased contents of surfactant proteins A and D in BAL fluids of healthy smokers. Chest. 1996; 109 1006-1009
- 34 Mancini N M, Bene M C, Gerard H. et al . Early effects of short-time cigarette smoking on the human lung: a study of bronchoalveolar lavage fluids. Lung. 1993; 171 277-291
- 35 Bode F R, Dosman J, Martin R R. et al . Reversibility of pulmonary function abnormalities in smokers. A prospective study of early diagnostic tests of small airways disease. Am J Med. 1975; 59 43-52
- 36 Willemse B W, Postma D S, Timens W. et al . The impact of smoking cessation on respiratory symptoms, lung function, airway hyperresponsiveness and inflammation. Eur Respir J. 2004; 23 464-476
- 37 Pearce A C, Jones R M. Smoking and anesthesia: preoperative abstinence and perioperative morbidity. Anesthesiology. 1984; 61 576-584
- 38 Cryer P E, Haymond M W, Santiago J V. et al . Norepinephrine and epinephrine release and adrenergic mediation of smoking-associated hemodynamic and metabolic events. N Engl J Med. 1976; 295 573-577
- 39 Ryter S W, Otterbein L E. Carbon monoxide in biology and medicine. Bioessays. 2004; 26 270-280
- 40 Turino G M. Effect of carbon monoxide on the cardiorespiratory system. Carbon monoxide toxicity: physiology and biochemistry. Circulation. 1981; 63 253A-259A
- 41 Kambam J R, Chen L H, Hyman S A. Effect of short-term smoking halt on carboxyhemoglobin levels and P50 values. Anesth Analg. 1986; 65 1186-1188
- 42 Ambrose J A, Barua R S. The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol. 2004; 43 1731-1737
- 43 Morita H, Ikeda H, Haramaki N. et al . Only two-week smoking cessation improves platelet aggregability and intraplatelet redox imbalance of long-term smokers. J Am Coll Cardiol. 2005; 45 589-594
- 44 Arcavi L, Benowitz N L. Cigarette smoking and infection. Arch Intern Med. 2004; 164 2206-2216
- 45 Zeidel A, Beilin B, Yardeni I. et al . Immune response in asymptomatic smokers. Acta Anaesthesiol Scand. 2002; 46 959-964
- 46 Gerrard J W, Heiner D C, Ko C G. et al . Immunoglobulin levels in smokers and non-smokers. Ann Allergy. 1980; 44 261-262
- 47 Ioka A, Nakamura M, Shirokawa N. et al . Natural killer activity and its changes among participants in a smoking cessation intervention program – a prospective pilot study of 6 months’ duration. J Epidemiol. 2001; 11 238-242
- 48 Hersey P, Prendergast D, Edwards A. Effects of cigarette smoking on the immune system. Follow-up studies in normal subjects after cessation of smoking. Med J Aust. 1983; 2 425-429
- 49 Jensen J A, Goodson W H, Hopf H W. et al . Cigarette smoking decreases tissue oxygen. Arch Surg. 1991; 126 1131-1134
- 50 Jorgensen L N, Kallehave F, Christensen E. et al . Less collagen production in smokers. Surgery. 1998; 123 450-455
- 51 Sorensen L T, Toft B, Rygaard J. et al . Smoking attenuates wound inflammation and proliferation while smoking cessation restores inflammation but not proliferation. Wound Repair Regen. 2010; 18 186-192
- 52 Sorensen L T, Karlsmark T, Gottrup F. Abstinence from smoking reduces incisional wound infection: a randomized controlled trial. Ann Surg. 2003; 238 1-5
- 53 Sorensen L T, Zillmer R, Agren M. et al . Effect of smoking, abstention, and nicotine patch on epidermal healing and collagenase in skin transudate. Wound Repair Regen. 2009; 17 347-353
- 54 Erhunmwunsee L, Onaitis M W. Smoking cessation and the success of lung cancer surgery. Curr Oncol Rep. 2009; 11 269-274
- 55 Lawson P J, Flocke S A. Teachable moments for health behavior change: a concept analysis. Patient Educ Couns. 2009; 76 25-30
- 56 Garces Y I, Yang P, Parkinson J. et al . The relationship between cigarette smoking and quality of life after lung cancer diagnosis. Chest. 2004; 126 1733-1741
- 57 Evangelista L S, Sarna L, Brecht M L. et al . Health perceptions and risk behaviors of lung cancer survivors. Heart Lung. 2003; 32 131-139
- 58 Baser S, Shannon V R, Eapen G A. et al . Smoking cessation after diagnosis of lung cancer is associated with a beneficial effect on performance status. Chest. 2006; 130 1784-1790
- 59 Skold C M, Forslid J, Eklund A. et al . Metabolic activity in human alveolar macrophages increases after cessation of smoking. Inflammation. 1993; 17 345-352
- 60 Celermajer D S, Sorensen K E, Georgakopoulos D. et al . Cigarette smoking is associated with dose-related and potentially reversible impairment of endothelium-dependent dilation in healthy young adults. Circulation. 1993; 88 2149-2155
- 61 Rival J, Riddle J M, Stein P D. Effects of chronic smoking on platelet function. Thromb Res. 1987; 45 75-85
- 62 Kotani N, Kushikata T, Hashimoto H. et al . Recovery of intraoperative microbicidal and inflammatory functions of alveolar immune cells after a tobacco smoke-free period. Anesthesiology. 2001; 94 999-1006
1 Diese Übersichtsarbeit wurde in ihren Grundzügen auf dem 51. Kongress der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e. V. im Rahmen eines Symposiums vorgestellt.
Dr. med. Tobias Raupach, MME
Universitätsmedizin Göttingen
Abteilung Kardiologie & Pneumologie
Robert Koch-Straße 40
37075 Göttingen
Email: raupach@med.uni-goettingen.de