Lobectomy vs. sublobar resection for congenital pulmonary airway malformations: a 10-year NSQIP-pediatric review

To directly compare clinical outcomes associated with lobectomy versus sublobar resections (segmentectomy or wedge resection) for pediatric congenital pulmonary airway malformations (CPAMs).

A retrospective review of the National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) was conducted from 2014 to 2023 to identify patients with CPAMs who underwent sublobar resection or lobectomy. Outcomes included operative time, 30-day mortality, and postoperative complication rates.

Lobectomy (n = 1,865; 88%) was performed far more often than sublobar resection (n = 245; 12%) (p < 0.0001). Children who underwent sublobar resection were 8.5 months older (mean age 25.0 vs. 16.5 months) (p < 0.01) and larger by 2.1 kg (mean weight 12.3 vs. 10.2 kg) (p < 0.05) on average. There was no difference in mortality (0.4% sublobar vs. 0.1% lobectomy) (p = 0.31). Segmentectomy was associated with significantly fewer 30-day complications compared to lobectomy (OR 0.08, p < 0.0001), primarily due to a decreased rate of postoperative blood transfusion (OR 0.12, p < 0.01). Sublobar resections had shorter operative times compared to lobectomy (133.6 ± 82.7 vs. 191.2 ± 85.9 min) (p < 0.0001). VATS was utilized more often than open surgery for both lobectomy (57.8%) and sublobar resections (54.7%) and was associated with lower 30-day complication rates (OR 0.58, p < 0.01) and total hospital length of stay (-1.48 days, p < 0.0001) after lobectomy.

Lobectomy is performed far more often than sublobar resection for the treatment of CPAMs in the United States. Sublobar resection is associated with shorter operative time. Anatomic sublobar resection (segmentectomy) is associated with decreased 30-day complication rates.