Outcomes of combined lung cancer resection and lung volume reduction surgery in adults with severe emphysema; a systematic review and meta-analysis

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Background: Severe emphysema can preclude potentially curative lung cancer resection. In selected patients, a volume-reduction strategy may allow cancer resection while removing hyperinflated, poorly functioning parenchyma. Methods: We systematically reviewed adults with severe emphysema undergoing lung cancer resection combined with LVRS, LVRS-like resection, or lobar resection producing a volume-reduction effect. PubMed, Semantic Scholar, OpenAlex, Scopus, Web of Science Core Collection, CENTRAL, ClinicalTrials.gov, the WHO ICTRP, and reference lists were searched to 27 May 2026. Primary outcomes were perioperative mortality and major complications. Secondary outcomes included FEV1 change, exercise capacity, dyspnoea, quality of life, survival, and recurrence. Single-arm meta-analyses were performed when at least three comparable studies reported extractable data. Results: Ten unique datasets met the review criteria; seven contributed to at least one quantitative synthesis. Three deaths occurred among 113 participants (crude mortality 2.7%); the sparse-event random-effects logit model estimated 7.3% (95% CI 3.4-15.1). FEV1 improved by a pooled mean of +0.26 L (95% CI + 0.20 to +0.32; four studies, 74 patients). Reported 5-year overall survival ranged from 35% to 68% in the most informative cohorts, but survival and recurrence data were too heterogeneous for definitive oncologic conclusions. Conclusions: In highly selected patients with severe emphysema and resectable lung cancer, combined resection and LVRS appears feasible and may preserve or improve pulmonary function. Only 3/113 perioperative deaths (2.7%) were directly observed; the 7.3% pooled model estimate is not an observed risk and is unstable with only three deaths. The procedure should not be interpreted as low risk: it carries substantial air-leak morbidity, the certainty of evidence is very low. These findings support specialist multidisciplinary consideration, not routine use. Candidate selection should require concordance between curative oncologic resectability and a CT-defined, poorly perfused LVRS target, together with acceptable global reserve after optimisation. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO, identifier CRD420261397321.

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