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Smoking cessation for less than 10 years remains a risk factor of anastomotic leakage in mid-to-low rectal cancer patients undergoing sphincter-preserving surgery

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Abstract

Purpose

Although cigarette smoking is a well-known risk factor for anastomotic leakage during rectal surgery, the proper duration of smoking cessation that can decrease anastomotic leakage in patients undergoing sphincter-preserving surgery is unclear. This study aimed to investigate the optimal duration of smoking cessation that can reduce this complication.

Methods

Between January 1, 2000, and December 31, 2012, we enrolled 1246 consecutive patients who underwent curative-intent sphincter-preserving surgery without preventive stoma at the Division of Colorectal Surgery of a tertiary referral center in Taiwan. Questionnaires were used to record their pre-surgical smoking status. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off duration of smoking cessation. Multivariate analysis was used to verify the effect of cigarette cessation on anastomotic leakage.

Results

The ROC curve showed a cut-off value of 10.5 years of cessation duration. Therefore, the former-smoker group was further divided using a cessation duration of 10 years. The overall anastomotic leakage rate was 5.29%. However, the anastomotic leakage rate in current smokers (9.3%) and in those who quit for < 10 years (12.9%) was significantly higher than that in non-smokers (3.3%) and those who quit for ≥ 10 years (4.5%). On multivariate analysis, current smokers (p = 0.022), former smokers with < 10 years of smoking cessation (OR 2.725; p = 0.029), male sex (p = 0.015), and low rectal cancer (p < 0.001) were all independently related to the development of anastomotic leakage.

Conclusion

Smoking cessation for < 10 years remains a risk factor for anastomotic leakage in patients with mid-to-low rectal cancer undergoing sphincter-preserving surgery.

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Data availability

The de-identificated data and material can be available after the approval of Chang Gung Medical Foundation institutional review board.

Code availability

There is no software application or custom code.

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Acknowledgements

The authors thank Professor Rei-Ping Tang from the Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, for establishing this database.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, No.5, Fuxing St., Guishan Dist., Taoyuan City, 33305, Taiwan

    Kun-Yu Tsai, Shu-Huan Huang, Jeng-Fu You, Reiping Tang, Jy-Ming Chiang, Chien-Yuh Yeh, Pao-Shiu Hsieh, Wen-Sy Tsai, Sum-Fu Chiang & Cheng-Chou Lai

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Contributions

Kun-Yu Tsai and Shu-Huan Huang had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Shu-Huan Huang, Kun-Yu Tsai, and Cheng-Chou Lai. Acquisition of data: all authors. Drafting of the manuscript: Kun-Yu Tsai and Shu-Huan Huang. Critical revision of the manuscript for importance and intellectual content: Cheng-Chou Lai and Shu-Huan Huang. Statistical analysis: Shu-Huan Huang. Administrative, technical, or material support: Cheng-Chou Lai and Jeng-Fu You. Study supervision: Cheng-Chou Lai.

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Correspondence to Cheng-Chou Lai.

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IRB approval was obtained from the Chang Gung Medical Foundation Institutional Review Board (IRB No. 202001577B0).

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Tsai, KY., Huang, SH., You, JF. et al. Smoking cessation for less than 10 years remains a risk factor of anastomotic leakage in mid-to-low rectal cancer patients undergoing sphincter-preserving surgery. Langenbecks Arch Surg 407, 1131–1138 (2022). https://doi.org/10.1007/s00423-021-02381-9

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