Multimodal Digital Health Interventions versus Standard Perioperative Management in Lung Cancer Surgery: A Systematic Review, Meta-Analysis, and Evidence Gap Map

<title>Abstract</title> <p>Purpose: Multimodal digital health interventions (DHIs) may extend perioperative monitoring, rehabilitation, symptom support, and care coordination for patients undergoing lung cancer surgery, but their comparative effectiveness has not been systematically mapped. This review evaluated multimodal DHIs versus conventional perioperative management across clinical, patient-reported, and implementation outcomes. Methods: Ten English and Chinese databases, trial registries, grey literature sources, conference proceedings, and reference lists were searched from inception to June 2026. Eligible studies were randomized or nonrandomized controlled studies of adults undergoing lung cancer surgery that used at least two digital modality categories. Risk of bias was assessed using RoB 2.0 and ROBINS-I logic. Compatible randomized trials were synthesized using random-effects meta-analysis; nonrandomized evidence was summarized narratively using SWiM. Certainty was rated with GRADE. Results: Eleven controlled studies including 2,088 participants were included. Randomized-trial syntheses favored multimodal DHIs for pulmonary function (3 RCTs; n = 345; SMD 0.705, 95% CI 0.137 to 1.272) and health-related quality of life (4 RCTs; n = 438; SMD 0.647, 95% CI 0.276 to 1.018), but certainty was very low and heterogeneity was substantial. Length of stay was directionally shorter but inconclusive. Anxiety, depression, and prolonged hospitalization favored DHIs in single-study analyses; postoperative pulmonary complications and pain could not be pooled. Conclusion: Multimodal DHIs show promising but very low-certainty evidence as adjuncts to perioperative lung cancer supportive care. Future trials should standardize outcome reporting, directly compare DHIs with multidisciplinary management, and evaluate implementation, equity, and cost outcomes. PROSPERO registration: CRD420261417858.</p>