Wearable technologies for perioperative recovery monitoring in lung cancer surgery: a systematic review of feasibility, recovery outcomes, and evidence certainty

Background Enhanced Recovery After Surgery (ERAS) pathways in thoracic oncology emphasize early mobilization and objective discharge readiness, but perioperative functional recovery is often assessed intermittently. Wearable devices may provide continuous, objective recovery metrics. Methods We conducted a PRISMA 2020-based systematic review registered in PROSPERO (CRD420261325339). PubMed, Scopus, and Web of Science Core Collection were searched for English-language studies published between February 2, 1996 and February 2, 2026. Eligible reports included adults undergoing lung cancer surgery or clinically relevant pulmonary resection and evaluated wearable-based activity, physiologic monitoring, or rehabilitation support across the preoperative, in-hospital, or post-discharge phases. Risk of bias was assessed using RoB 2, ROBINS-I, or design-appropriate feasibility and measurement appraisal. Certainty of evidence was qualitatively informed by GRADE principles, and findings were synthesized narratively because of clinical and methodological heterogeneity. Results Eight reports representing seven independent cohorts were included: two randomized trials, one nonrandomized trial with historical controls, two prospective observational studies, two companion single-arm preoperative feasibility/effectiveness reports, and one development/usability agreement study. In the Move For Surgery RCT, wearable-enhanced preconditioning reduced prolonged hospital stay >5 days from 24% to 7% (12/50 vs 3/45; p =0.021). A digital chest drainage RCT reported shorter postoperative length of stay and chest tube duration in the intervention group, although the cohort was not restricted to lung cancer. Observational studies showed weak but significant associations between perioperative step counts and recovery outcomes. Feasibility studies supported device use and data transmission, while a smartwatch-ePRO study showed close agreement with electronic health record measurements. Conclusions Wearable-based perioperative monitoring appears feasible and may provide objective recovery signals in lung cancer surgery. However, current evidence remains sparse, heterogeneous, and often indirect. Findings should be interpreted as hypothesis-generating rather than sufficient to support routine clinical implementation. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261325339 , identifier CRD420261325339.