Smoking has a major role in the risk of postoperative pulmonary complications. We aimed to elucidate the correlation between smoking status and pulmonary complications following thoracoscopic surgery for lung cancer.

A total of 1,751 patients who underwent thoracoscopic lobectomy or segmentectomy for lung cancer between April 2011 and March 2020 were assessed. The rate of pulmonary complications was evaluated according to smoking status and preoperative duration of smoking cessation. Univariate and multivariate logistic regression analyses were performed.

Pulmonary complications were observed in 50 patients (2.9%), while 3 (0.2%) died within 90 days of surgery. The rate of pulmonary complications was higher in smokers than in nonsmokers (4.6% vs. 0.9%, p < 0.001), and smoking history was an independent risk factor of pulmonary complications (odds ratio = 3.31, p = 0.007). The complication rate in patients with a cessation period of > 2 months was significantly lower than that in those who ceased smoking within 2 months (4.0% vs. 8.5%, p = 0.043), but it was still higher than that in nonsmokers (4.0% vs. 0.9%, p < 0.001). In the multivariable analysis for smokers, preoperative short-term smoking cessation within 2 months, male sex, histology, tumor size, and cardiopulmonary comorbidities were associated with pulmonary complications instead of pack-year smoking history.

Smoking habits and preoperative smoking cessation were independently associated with pulmonary complications after thoracoscopic surgery for lung cancer. A preoperative smoking cessation period of 2 months or more is preferable for reducing the risk of such complications.