Trends in surgical approach and pediatric pulmonology follow-up for operated congenital thoracic malformations

Vollständiger Abstract

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Introduction Congenital thoracic malformations (CTM) including congenital pulmonary airway malformation (CPAM), pulmonary sequestration (PS), bronchogenic cysts (BC), congenital lobar overinflation (CLO), and bronchial atresia (BA) are increasingly detected antenatally. Resection is generally undertaken in symptomatic patients, whereas the management of asymptomatic lesions remains controversial, with no consensus on whether or when to operate. We compared children who underwent surgery for CTMs after antenatal versus postnatal diagnosis. Methods Pediatric patients who underwent resection of histopathologically confirmed CTM at a single tertiary center between August 2019 and December 2025, with at least 6 months' follow-up, were retrospectively evaluated for surgical approach [thoracotomy/video-assisted thoracoscopic surgery (VATS)], length of hospitalization, age at operation, and clinical, anthropometric, and spirometric outcomes at the last visit. Results Fifty-six patients were included [29 (51.80%) male; median age at final visit 54.00 months]. Antenatal diagnosis occurred in 34 (60.70%), and CPAM was the most frequent lesion (50.00%). Preoperative radiology and postoperative histopathology were concordant in 80.40%. Median age at surgery was numerically lower in prenatally diagnosed patients, but the difference was not statistically significant (11.00 vs. 33.50 months, p = 0.087). VATS was performed in 43 (76.80%) and thoracotomy in 13 (23.20%). During follow-up, scoliosis occurred in 10 (17.90%) and pectus deformity in 8 (14.30%). Spirometry, available in 15 patients (26.70%), was within near-normal ranges (FVC z-score −0.77; FEV 1 z-score −0.84). Median weight and height z-scores were −0.15 and −0.01. Conclusion In this single-center retrospective cohort, somatic growth after resection of CTM was generally normal and lung function largely preserved, with infrequent chronic respiratory morbidity. No statistically significant differences were detected between antenatally and postnatally diagnosed patients, although the study was underpowered to exclude smaller differences and spirometry was available in only a subset of children. These observations are hypothesis-generating and support comprehensive, family-centered long-term follow-up.