Scoping Review of Operative Management of Thoracic Malignancies in Patients With Psychiatric Comorbidities

J Surg Res. 2025 Sep 6;314:671-689. doi: 10.1016/j.jss.2025.08.006. Online ahead of print.

ABSTRACT

INTRODUCTION: Psychiatric comorbidities are increasingly recognized in patients with thoracic malignancies. We undertook this scoping review to characterize the management of thoracic malignancies in patients with psychiatric illness and uncover any disparities in operative treatment or perioperative outcomes.

METHODS: We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Full-text English articles were identified in PubMed, Embase, and APA PsycInfo published between January 01, 2000, and August 01, 2024. Eligible articles included experimental, quasiexperimental, and observational studies that involved adult patients with psychiatric conditions, thoracic malignancies, and surgical interventions. Data on diagnostic stage, guideline-based interventions, and patient health outcomes were extracted and analyzed.

RESULTS: A total of 5050 studies were identified and screened by two reviewers: 235 met the criteria for full-text review and 31 were included for data extraction. Among the included articles, 26 assessed lung cancer and seven assessed esophageal cancer. The most frequently investigated psychiatric comorbidities were substance use disorder (n = 13), alcohol use disorder (n = 12), depression (n = 11), anxiety (n = 8), psychotic disorders (n = 7), and cognitive disorders (n = 7). Although the nature of the observed disparities varied by specific conditions, the presence of a psychiatric comorbidity was associated with delayed diagnoses, lower rates of surgical intervention, longer length of stay, increased perioperative morbidity, and higher mortality rates.

CONCLUSIONS: Psychiatric illness is common in patients with thoracic malignancy with heterogeneous effects on treatment and outcomes. There is a need for targeted treatment plans to alleviate the identified disparities and optimize care.

PMID:40915036 | DOI:10.1016/j.jss.2025.08.006