Z. El-Zein1, S. Barnett1, J. Lin1, W. Lynch1, R. Reddy1, A. Chang1, M. Orringer1, P. Carrott1 1University Of Michigan,Section Of Thoracic Surgery,Ann Arbor, MI, USA
Introduction: We aimed to determine if preoperative counseling for esophagectomy patients led to durable smoking cessation, routine exercise for years after surgery, and lower postoperative complication rates.
Methods: Of 789 patients identified as long-term survivors from a prospectively-collected esophagectomy database, 393 (49.8%) were contacted and agreed to receive a survey of long-term lifestyle changes. Of 294/393 (74.8%) patients who returned the completed survey, 239 (81.3%) underwent esophagectomy for cancer (median follow-up 5.5 years) and 55 (18.7%) for benign disease (median follow-up 9.2 years). Each group was analyzed using descriptive statistics and Chi-square where appropriate.
Results: In the cancer population, 35/239 (14.6%) were smokers at preoperative counseling and 14/35 (40%) smoked following surgery (P<0.01). With regard to exercise, 177/239 (74.1%) reported counseling preoperatively and 62/239 (25.9%) reported no counseling. The median exercise frequency for the counseled group was 5 vs. 2 days/week for the “non-counseled” group preoperatively (p<0.0001) and 4 vs. 3 days/week postoperatively (P=0.02). Currently, 117/177 (66.1%) in the counseled group exercise regularly (2+ days/week for 30+ minutes) compared to 31/62 (50%) from the “non-counseled” group (p=0.02). In the cancer population, preoperative smokers had higher pneumonia rates than non-smokers (11.4% vs. 3.9%, P=0.06). The documented exercise-counseled group had a significantly lower pneumonia rate than the non-counseled group (3.2% vs. 11.5%, P=0.01). In the benign population, there was no significant reduction in smoking rates and no significant difference in exercise frequency or complication rates between the counseled and non-counseled groups.
Conclusion: Preoperative interventions before a major operation such as an esophagectomy due to cancer lead to an increase in activity level, permanent changes in lifestyle habits, and lower postoperative complication rates.