A novel procedure based on discernible demarcations for congenital lung malformation: a retrospective controlled...

There is no procedure exclusively designed for congenital lung malformation (CLM) in the literature. This study aims to propose a novel procedure and evaluate its safety and efficacy in treating CLM patients.

A retrospective review of clinical data was conducted for patients who underwent thoracoscopic anatomical lesion resection (TALR), thoracoscopic lobectomy (TL), and thoracoscopic segmentectomy (TS) in our hospital from January 2018 to December 2023. Intraoperative and postoperative outcomes were compared between the groups. Besides, preoperative CT scan image and intraoperative videos of the patients who underwent TALR were reviewed.

Of all patients, 259 patients in TALR group, 100 in TL group, and 112 in TS group were included for comparative analysis. More operative time was used in TALR group compared to lobectomy (108 min vs. 61 min, P < 0.001) and segmentectomy (108 min vs. 80 min, P < 0.001), respectively. The parameters such as major bleeding rate, air leak rate, and remnant lesion rate in TALR group were not inferior to that in groups of lobectomy and segmentectomy. In 259 (91.5%) patients, the normal lung exhibited a lobular structure resembling a turtle shell which can be distinguished from the lesion thus forming a clear external lesion boundaries. Additionally, the internal lesion demarcation can be marked by the pulmonary veins from CT scan image.

Lesion boundaries are present in CLM, with most being identifiable on CT image and visible on the surface of the lobe to the naked eye. These findings could contribute to the advancement of TALR which was comparable to TL and TS in terms of safety and efficacy.