Perioperative Antifibrotic Treatment and Early Postoperative Outcomes in Patients With Idiopathic Pulmonary Fibrosis Undergoing Lung Cancer Surgery: A Systematic Review and Meta-Analysis.
Sanagawa Akimasa A, Kato Hideo H, Fujimoto Hajime H, Kobayashi Tetsu T et al.
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; I2 = 0%) and 90 days (RR, 0.23; 95% CI, 0.09-0.57; I2 = 0%). AFT was associated with lower mortality at 30 days (RR, 0.12; 95% CI, 0.02-0.91; I2 = 0%) and 90 days (RR, 0.13; 95% CI, 0.02-0.76; I2 = 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.