# Integrating Surgery and Ablative Therapies for the Management of Multiple Primary Lung Cancer: A Systematic Review

## TL;DR

Combining surgery and ablation for multiple lung tumors is safe and effective, preserving lung tissue and offering personalized treatment.

## Contribution

This systematic review introduces a combined surgical and ablative approach as a novel, organ-preserving treatment for multiple primary lung cancer.

## Key findings

- Combined therapy showed a pooled ablation efficacy rate of 97.11%.
- Adverse event rates were low, at 14.23% on average.
- The approach allows for tailored treatment and better lung function preservation.

## Abstract

Multiple primary lung cancer (MPLC) is becoming more common with increased use of chest imaging. Treating patients with many lung tumors is challenging, as traditional surgery may not be suitable or necessary for all lesions. Ablation, a minimally invasive technique that destroys tumors using heat or cold, has shown promise for managing selected lesions. This review explores the use of combining surgery and ablation to treat MPLC. Based on the available evidence, this integrated approach appears to be safe and effective, with promising success rates and relatively few complications. It allows for preservation of more lung tissue and tailoring of treatment to individual patient needs. Our findings suggest that this strategy may offer a valuable treatment option, potentially preserving more lung function compared to extensive surgery alone, especially for patients with multiple or hard-to-reach tumors. These insights could inform future treatment guidelines and support more personalized care for patients with complex lung cancer.

Background: Multiple primary lung cancer (MPLC) presents clinical challenges due to its biological complexity. While lobectomy remains standard, limited resection and localized ablation offer comparable efficacy. This systematic review evaluates the safety and efficacy of combining surgical and ablative therapies for MPLC. Methods: A comprehensive search of PubMed, Embase, and Web of Science (January 2000–2025) identified studies involving MPLC patients treated with both surgery and ablation, either concurrently or sequentially. Data on ablation efficacy, adverse events, and prognosis were extracted. A meta-analysis was performed when data pooling was appropriate. The methodological quality and risk of bias of the included studies were assessed using the MINORS and ROBINS-I tools. Publication bias was evaluated through funnel plots and Egger’s linear regression test. Furthermore, one case report on combination therapy was also included. Results: A total of nine studies met the inclusion criteria and were included in the final analysis. All reported a 100% technical success rate for ablation, efficacy rates exceeding 70%, and adverse event rates ranging from 5.0% to 26.7%. Due to significant heterogeneity among studies, a random-effects model was applied. The meta-analysis yielded a pooled ablation efficacy rate of 97.11% (95% CI: 85.81–100.00%) and a pooled adverse event rate of 14.23% (95% CI: 8.07–20.38%), indicating favorable safety and efficacy of the combined therapy. Conclusions: The integration of surgical and ablative therapies offers a safe and effective strategy for managing MPLC and supports a potential paradigm shift from single-modality treatment toward a more personalized, organ-preserving, and patient-centered approach.