Präoperative Tabakentwöhnung bei Patienten mit Bronchialkarzinom[*]

Zusammenfassung

Eine erfolgreiche Tabakentwöhnung verbessert bei Patienten mit Bronchialkarzinom die Prognose quoad vitam. Dennoch wird Rauchern mit einem nicht-kleinzelligen Bronchialkarzinom und geplanter kurativer Resektion häufig davon abgeraten, das Rauchen in der unmittelbaren präoperativen Phase einzustellen. Diese Empfehlung stützt sich auf eine prospektive Kohortenstudie aus dem Jahre 1998, in der eine Reduktion des Tabakkonsums in den letzten acht Wochen vor einem nicht-thorakalen Eingriff mit einer Erhöhung des Risikos für perioperative pulmonale Komplikationen einherging. Zwar wurden in den vergangenen 12 Jahren zahlreiche weitere Beobachtungsstudien zu den Auswirkungen einer präoperativen Entwöhnung auf das perioperative Risiko bei thorakalen und nicht-thorakalen Operationen publiziert – nur sechs dieser Arbeiten bezogen sich jedoch auf Patienten mit Lungentumoren. Aufgrund methodischer Schwächen und der großen Heterogenität der untersuchten Patientengruppen lässt sich aus den vorliegenden Daten keine Empfehlung für oder gegen einen Rauchstop in der unmittelbaren präoperativen Phase ableiten. Unter Berücksichtigung der für perioperative Komplikationen relevanten pathophysiologischen Prozesse und des zeitlichen Verlaufs ihrer Erholung nach einer Tabakentwöhnung erscheint eine mindestens zwei- bis sechswöchige präoperative Rauchkarenz sinnvoll; im Kontext der meist dringlichen Indikation zur kurativen Resektion erscheint dies zuweilen unrealistisch. Da aber auch kürzere präoperative Abstinenzphasen die Prognose nicht nachweislich verschlechtern, sollten Patienten mit Bronchialkarzinom eine Empfehlung zur präoperativen Tabakentwöhnung erhalten.

Abstract

Successful smoking cessation is associated with a survival benefit for patients with lung cancer. However, smokers newly diagnosed with non-small cell lung cancer and scheduled for curative resection are frequently discouraged from stopping smoking in the immediate preoperative period. This recommendation is based on the results of one single prospective cohort study published in 1998 which reported an increased risk of perioperative pulmonary complications in patients undergoing non-thoracic surgery who had reduced their tobacco consumption within the two months leading up to the operation. During the past 12 years, numerous observational studies have investigated the impact of preoperative smoking cessation on perioperative risk for thoracic and non-thoracic surgery. However, no more than six studies included patients with pulmonary neoplasms. Owing to methodological limitations and considerable heterogeneity of the included patient groups, the existing data are insufficient to support or refuse any recommendation regarding cessation advice for patients during the immediate preoperative phase. In view of the post-cessation recovery time-course of pathophysiological alterations relevant to the occurrence of perioperative complications, a smoke-free preoperative interval of 2 – 6 weeks appears most favourable. However, this is difficult to achieve as a curative resection should not be postponed. Since there is no scientific evidence demonstrating a negative impact of preoperative smoking cessation on prognosis, patients newly diagnosed with lung cancer should be encouraged to make an attempt to quit while waiting for thoracic surgery.

1 Diese Übersichtsarbeit wurde in ihren Grundzügen auf dem 51. Kongress der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e. V. im Rahmen eines Symposiums vorgestellt.

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1 Diese Übersichtsarbeit wurde in ihren Grundzügen auf dem 51. Kongress der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e. V. im Rahmen eines Symposiums vorgestellt.