LAUSR

This study aimed to characterise morbidity and mortality profile by smoking status in patients undergoing oesophagectomy for oesophageal cancers. Oesophagectomy remains the mainstay for curative treatment of oesophageal cancer. Despite improvements in perioperative care, little is understood on the impact of smoking status on perioperative morbidity and mortality following oesophagectomy for oesophageal cancers. Consecutive patients undergoing oesophagectomy cancer (adenocarcinoma or squamous cell carcinoma) between 1997 - 2016 at the Northern Oesophagogastric Unit were included from a contemporaneously maintained database. Primary outcome was overall survival. Secondary outcomes include overall complications, anastomotic leaks and pulmonary complications. During the study period, 1207 patients underwent oesophagectomy for cancer. Of these 1207 patients, most were current (74%) smokers with only 20% non-smokers. Median survival of current smokers was significantly shorter than ex-smokers and non-smokers (median: 35 vs 42 vs 44 months, p=0.031). On adjusted analysis, there were no significant difference in survival between non-smokers and ex-smokers with current smokers. Rates of overall complications were significantly higher with current smokers compared to ex-smokers or non-smokers (73% vs 66% vs 62%, p=0.015). There were no significant differences in anastomotic leaks and pulmonary complications between the groups. In summary, this study demonstrated that current smokers have significantly reduced long-term survival compared to ex-smokers or never smokers, specifically patients undergoing surgery only or those with SCC. Future studies in patients with neoadjuvant therapy to further delineate genetic landscape of oesophageal cancers to identify high risk groups that may warrant further multimodality therapy.