Comparison between segmentectomy and lobectomy for treating congenital lung malformation: A NSQIP database study

Congenital pulmonary airway malformation (CPAM) and bronchopulmonary sequestration (BPS) are diagnosed more often now than in past decades, largely because prenatal imaging has improved substantially. Thoracoscopic lobectomy is still the default operation, though anatomic segmentectomy has gained traction to spare healthy lung tissue. We used a national pediatric surgical database to compare the two approaches during the first 30 days after surgery.

Patients under 19 years of age with CPAM or BPS who underwent thoracoscopic lobectomy or segmentectomy were identified in the National Surgical Quality Improvement Program Pediatric (NSQIP-P) between 2015 and 2023. We compared operative time (duration of surgery and anesthesia), postoperative length of stay, and 30-day complications, and then repeated the comparison after 1:1 propensity matching for age, sex, race, weight, American Society of Anesthesiologists (ASA) Physical Status Classification, wound classification, and relevant comorbidities.

Among 1520 patients (1404 lobectomies, 116 segmentectomies), the matched groups (84 per arm) showed a clear operative time advantage for segmentectomy, 117.6 ± 62.5 vs. 185.4 ± 92.4 min (p < 0.001), and a shorter hospital stay, 2.00 ± 2.05 vs. 2.65 ± 2.53 days (p = 0.001). Surgical time alone was shorter with segmentectomy but was not significant (83.0 ± 31.2 vs. 92.8 ± 35.7 min; p = 0.061). Complications, reoperations, readmissions, and transfusion rates didn't differ meaningfully between groups, and there were no deaths.

Segmentectomy appears to offer real operative and recovery advantages over lobectomy without a safety tradeoff, at least in this short-term window. Longer follow-up is still warranted before concluding effects on lung function or recurrence.

Level III.