David G1#, West MA2,3#, Magee CJ1 and Walsh CJ1*
1Department of Surgery, Wirral University Teaching Hospital NHS Foundation Trust, UK
2Academic Unit of Cancer Sciences, University of Southampton, UK
3Department of Surgery, University Hospital Southampton NHS Foundation Trust, UK
#Both authors have contributed equally to this work
Background: Cigarette smoking adversely affects the natural history of a number of common colorectal conditions and their treatment. Colorectal cancer is now recognised as a smoking attributable cancer.Aim: This is a narrative review of the effects of cigarette smoking on colorectal disease, colorectal surgery and colorectal surgical outcomes.Methods: Literature search was carried out for relevant articles highlighting relationship between smoking and variety of colorectal conditions (cancer, diverticular disease, inflammatory bowel disease and perianal diseases). As we wanted to highlight the breadth of the problem to current colorectal practice, we have deliberately kept this as a narrative review.Results: Smoking is associated with higher all-cause mortality and colorectal cancer–specific mortality in non-metastatic colorectal cancer and it worsens the outcomes of a number of inflammatory colorectal conditions including diverticular disease and Crohn’s disease. Smoking impairs the inflammatory response, tissue repair and consequently impairs wound healing. Smoking during radiotherapy worsens acute toxicity and reduces disease free survival in anal cancer.Conclusion: Approximately 10 million adults smoke cigarettes in Great Britain currently and therefore there is arguably no single greater reversible patient related parameter that affects outcomes in colorectal practice. Surgeons must advocate and facilitate smoking cessation in their patients putting particular emphasis on the likelihood of increased complication rates and poorer outcomes if an active smoker undergoes colorectal surgery or radiotherapy.
Smoking; Colorectal Disease; WHO
David G, West MA, Magee CJ, Walsh CJ. Smoking, Colorectal Disease and Colorectal Surgical Practice. Clin Surg. 2016; 1: 1115.