Perioperative Antifibrotic Treatment and Early Postoperative Outcomes in Patients With Idiopathic Pulmonary Fibrosis Undergoing Lung Cancer Surgery: A Systematic Review and Meta‐Analysis
- 1Department of Pharmacy Mie University Hospital Tsu Mie Japan
- 2Division of Clinical Medical Science, Department of Clinical Pharmaceutics Mie University Graduate School of Medicine Tsu Mie Japan
- 3Department of Pulmonary and Critical Care Medicine Mie University Faculty and Graduate School of Medicine Tsu Mie Japan
Abstract
Patients with idiopathic pulmonary fibrosis (IPF) undergoing lung cancer surgery are at high risk of acute exacerbation of IPF (AE‐IPF), which is associated with high mortality. Although antifibrotic therapy (AFT) has been proposed as a preventive strategy, evidence remains limited and heterogeneous, particularly regarding early postoperative outcomes. We systematically searched major databases, including PubMed and Ichushi‐Web, through August 2025 to evaluate perioperative AFT in patients with IPF undergoing surgery. Eligible studies reported postoperative AE‐IPF or mortality within 30–90 days. Risk ratios (RRs) and 95% confidence intervals (CIs) were pooled using common‐ and random‐effects models. Five retrospective cohort studies predominantly evaluating pirfenidone were included. AFT was associated with a lower incidence of postoperative AE‐IPF both within 30 days (RR, 0.24; 95% CI, 0.07–0.76; I 2 = 0%) and 90 days (RR, 0.23; 95% CI, 0.09–0.57; I 2 = 0%). AFT was associated with lower mortality at 30 days (RR, 0.12; 95% CI, 0.02–0.91; I 2 = 0%) and 90 days (RR, 0.13; 95% CI, 0.02–0.76; I 2 = 0%). Sensitivity analyses, including a nationwide database study, supported the association, although the effect was attenuated. Evidence for nintedanib was limited to a small case series. Perioperative AFT, particularly with pirfenidone, was associated with lower rates of AE‐IPF and mortality, including within 30 days post‐lung cancer surgery. These findings underscore the clinical relevance of early postoperative outcomes and support further prospective studies to clarify the role of perioperative AFT.
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BibTeX
@article{sanagawa2026perioperative,
title = {{Perioperative Antifibrotic Treatment and Early Postoperative Outcomes in Patients With Idiopathic Pulmonary Fibrosis Undergoing Lung Cancer Surgery: A Systematic Review and Meta‐Analysis}},
author = {Akimasa Sanagawa and Hideo Kato and Hajime Fujimoto and Tetsu Kobayashi and Takuya Iwamoto},
journal = {Thoracic Cancer},
year = {2026},
month = oct,
doi = {10.1111/1759-7714.70408},
url = {https://doi.org/10.1111/1759-7714.70408},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Perioperative Antifibrotic Treatment and Early Postoperative Outcomes in Patients With Idiopathic Pulmonary Fibrosis Undergoing Lung Cancer Surgery: A Systematic Review and Meta‐Analysis
AU - Akimasa Sanagawa
AU - Hideo Kato
AU - Hajime Fujimoto
AU - Tetsu Kobayashi
AU - Takuya Iwamoto
PY - 2026
DA - 2026/10/01
JO - Thoracic Cancer
DO - 10.1111/1759-7714.70408
UR - https://doi.org/10.1111/1759-7714.70408
AB - Patients with idiopathic pulmonary fibrosis (IPF) undergoing lung cancer surgery are at high risk of acute exacerbation of IPF (AE‐IPF), which is associated with high mortality. Although antifibrotic therapy (AFT) has been proposed as a preventive strategy, evidence remains limited and heterogeneous, particularly regarding early postoperative outcomes. We systematically searched major databases, including PubMed and Ichushi‐Web, through August 2025 to evaluate perioperative AFT in patients with IPF undergoing surgery. Eligible studies reported postoperative AE‐IPF or mortality within 30–90 days. Risk ratios (RRs) and 95% confidence intervals (CIs) were pooled using common‐ and random‐effects models. Five retrospective cohort studies predominantly evaluating pirfenidone were included. AFT was associated with a lower incidence of postoperative AE‐IPF both within 30 days (RR, 0.24; 95% CI, 0.07–0.76; I 2 = 0%) and 90 days (RR, 0.23; 95% CI, 0.09–0.57; I 2 = 0%). AFT was associated with lower mortality at 30 days (RR, 0.12; 95% CI, 0.02–0.91; I 2 = 0%) and 90 days (RR, 0.13; 95% CI, 0.02–0.76; I 2 = 0%). Sensitivity analyses, including a nationwide database study, supported the association, although the effect was attenuated. Evidence for nintedanib was limited to a small case series. Perioperative AFT, particularly with pirfenidone, was associated with lower rates of AE‐IPF and mortality, including within 30 days post‐lung cancer surgery. These findings underscore the clinical relevance of early postoperative outcomes and support further prospective studies to clarify the role of perioperative AFT.
SN - 1759-7706
SN - 1759-7714
ER -