Impact of Smoking Habit on Perioperative Morbidity in Patients Treated with Radical Cystectomy for Urothelial Bladder Cancer: A Systematic Review and Meta-analysis

Context: Smoking habit at the time of surgery is associated with higher periopera- tive complications and mortality across different types of surgeries. In recent years, several studies have attempted to explore the influence of smoking on periopera- tive outcomes following radical cystectomy (RC) for urothelial bladder cancer (UBC) with contradictory results. Objective: Tosystematicallyinvestigateandmeta-analyzetheassociationbetween smoking habit and perioperative morbidity and mortality in UBC patients treated with RC. Evidence acquisition: A systematic review of the literature published between January 2000 and January 2020 investigating the impact of smoking habit on perioperative outcomes of patients treated with RC for UBC was performed according to the Preferred Reporting Items for Systematic reviews and Meta- Analyses (PRISMA) statement and the Cochrane Handbook for Systematic Reviews of Interventions. Evidence synthesis: Overall, 27 articles involving 27 854 patients were included in the systematic review, and of these, 11 studies were included in the meta-analysis. The studies included showed a moderate to high risk of bias. Smoking status (smokers vs nonsmokers) was significantly associated with the onset of major postoperative complications (hazard ratio [HR] 1.87, 95% confidence interval [CI] 1.51–2.32; I2 = 0%), infections (HR 1.34, 95% CI 1.02–1.72; I2 = 66.2%), and mortality (HR 1.84, 95% CI 1.14–2.98; I2 = 4.9%). Conclusions: Smoking status at the time of RC is associated with increased risk for major postoperative complications, infections, and mortality. These results suggest the need for strict postoperative monitoring in smokers due to the increased risk of experiencing adverse events and underline the need for intensive smoking cessa- tion interventions in the preoperative setting.