Perioperative management for the prevention of postoperative pneumonia with esophageal surgery.

Received April 2, 2009; accepted for publication May 7, 2009 Address reprint requests to Yasunori Akutsu, MD: Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1–8–1 Inohana, Chuo-ku, Chiba 260–8670, Japan. ©2009 The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery. All rights reserved. smoking cessation is an effective strategy to prevent postoperative pulmonary complications. A decrease in these complications by smoking cessation is closely associated with physiological improvements in ciliary action, macrophage activity, small airway function, decreases in sputum production, among others. So smoking cessation is encouraged for a certain period prior to surgery. The incidence of postoperative pulmonary complications is 22.0% in current smokers, 12.8% in past smokers, and 4.9% in never smokers, respectively. Barrera et al. evaluated 300 patients who had undergone thoracic surgery and divided them into 4 groups: nonsmokers, past quitters (who stopped smoking > 2 months), recent quitters (who stopped > 1 week and ≤ 2 months) and ongoing smokers. The incidence of postoperative pneumonia was significantly different (p = 0.04) between nonsmokers and all smokers in the 4 groups, (3%, 10%, 15%, and 23%, respectively). Thus preoperative smoking cessation is recommended at least 1 month or more before surgery. However, there is no such data concerning esophagectomies.