N. Rozich1, A. Landmann1, M. Bonds1, L. Fischer1, R. Postier1, K. Morris1 1University Of Oklahoma College Of Medicine,General Surgery,Oklahoma City, OK, USA
Introduction: Cigarette smoking is an established risk factor for the development of pancreatic adenocarcinoma, however, there is little data regarding its effects on postoperative morbidity after pancreaticoduodenectomy. While most surgeons encourage smoking cessation, there is limited evidence to support the argument that smoking increases post-operative complications. We hypothesize that cigarette smoking is associated with higher morbidity rates following pancreatic head resection.
Methods: A retrospective review of all patients undergoing pancreaticoduodenectomy from 2011-2016 at a single institution was performed. Demographic data, including co-morbidities and post-operative complications were recorded and analyzed based on smoking history (never-smoker versus any history of smoking). Univariate and multivariable analyses were performed using SPSS version 24 (IBM Corp., Armonk, NY). P-values of less than 0.05 were considered significant.
Results: 220 patients met inclusion criteria. On univariate analysis, there was a significant difference in younger age at diagnosis (65.3 versus 68.4 years, p=0.019), male gender (63.4% versus 43.3%, p=0.004), and fistula rate (37% versus 18%, p=0.040) between smokers and never-smokers. There were trends towards higher rates of postoperative intra-abdominal abscesses, pneumonia, and cardiac complications. There was no significant difference in terms of BMI, diabetes, neoadjuvant therapy, delayed gastric emptying, readmission, or hospital length of stay between smokers and never-smokers. On multivariable analysis, fistula rate had an OR of 0.510 for women (p=0.046) and OR 0.557 for never-smokers (p=0.085). In analysis of gender differences, we found that male sex was significantly associated with fistula rate (31% vs 17%, p=0.019) and that smoking history was significantly related to fistula formation only in the male cohort (37% versus 19%, p=0.040 in men and 18% versus 16%, p=0.851 in women).
Conclusion: Smoking status was associated with a significant increase in postoperative pancreatic fistula rate following pancreaticoduodenectomy in men. Further studies are needed to determine if smoking cessation before surgery decreases this risk, and if so, the duration of cessation optimal to minimize morbidities.