Lobectomy versus lung-sparing resection for congenital pulmonary airway malformation (CPAM): a single-center comparative study

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AIM: To compare perioperative and long-term outcomes of lobectomy versus lung-sparing resection in children undergoing surgery for congenital pulmonary airway malformation (CPAM). METHODS: A retrospective single-center study was conducted including children who underwent primary surgical resection for postnatally confirmed CPAM between 2005 and 2024. Patients with other congenital lung lesions, bilateral disease, syndromic conditions, or incomplete data were excluded. Perioperative variables, postoperative outcomes, redo surgery, and chest wall anomalies were compared between lobectomy and lung-sparing resections. Continuous variables were analyzed using the Mann-Whitney U test and categorical variables using Fisher's exact test. RESULTS: Thirty-one children were included (22 lobectomies, 9 lung-sparing resections), with a median age at surgery of 8 months. Operative time (207 vs. 149 min, p = 0.0425) and anesthesia time (371 vs. 230 min, p = 0.0171) were significantly longer for lobectomy. Intraoperative complications occurred in 10% of patients, with no significant difference between groups. Postoperative complications were less frequent after lobectomy (19% vs. 44%), although not statistically significant (p = 0.1954). Redo surgery was required exclusively after lung-sparing resections (33% vs. 0%, p = 0.0207). Length of hospital stay and NICU/PICU stay were comparable. At a median follow-up of 71 months, chest wall deformities were observed less often after lobectomy (22% vs. 43%, p = 0.3554). CONCLUSIONS: Despite longer operative and anesthesia times, lobectomy provided more definitive disease control, with a significantly lower need for redo surgery compared with lung-sparing resection. Lobectomy remains the most reliable surgical option for CPAM in children, while lung-sparing approaches should be reserved for carefully selected cases.

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