Long-term outcome of surgery for lung cancer in Africa: a systematic review and meta-analysis.

Abstract

Background: Lung cancer is the leading cause of cancer death worldwide, with an estimated 1.8 million deaths in 2020. Despite the advancement of new treatment strategies that have emerged over time, surgery remains a very important aspect of cancer treatment. This study aims to highlight the long-term outcomes of surgery as well as the healthcare gaps in the diagnosis and treatment of Lung cancer in Africa by providing a comprehensive systematic review and meta-analysis.

Methods: This systematic review was conducted using database searches from PubMed and Google Scholar to identify published data reporting on the surgical outcomes of lung cancer in Africa from inception till August 2024. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to conduct this study. The primary outcomes of interest were overall mortality, 1- and 5-year survival rates, metastasis, morbidity and recurrence. Data were pooled together and analysed using a random-effect model for meta-analysis with R software. Out of a total of 381 articles identified, only eight papers met our inclusion criteria following deduplication and screening. The five countries with published research on our topic include Egypt, Kenya, Tunisia, Nigeria and Morocco, with a total sample size of 2150 patients.

Results: The meta-analysis of the reported outcomes produced an overall mortality rate of 27%, a 1-year survival rate of 56%, a 5-year survival rate of 13%, metastases of 76.9%, morbidity of 7.7% and recurrence of 11.4%.

Conclusion: The burden of lung cancer is relatively high across the African continent, with surgical treatment significantly underutilised due to several factors, including an inadequate number of skilled healthcare workers, limited cardiothoracic surgical services and the advanced stage at which most patients present. Nevertheless, there is room for improvement by addressing these gaps through targeted investments in cardiothoracic surgical training, research and infrastructure, alongside increased awareness of lung cancer and the benefits of screening services across Africa. These measures, combined with joint international and governmental funding efforts, could significantly improve survival outcomes.