Meta-analysis: Lobectomy vs segmentectomy for congenital lung malformations shows similar LOS, complications, pulmonary function

This systematic review and meta-analysis compared the efficacy and safety of lobectomy versus lung-sparing segmentectomy for congenital lung malformations (CLMs) in pediatric patients. The study included nine retrospective observational studies involving infants and children. The primary outcome was length of hospital stay (LOS). Secondary outcomes included operative time, chest tube removal duration, pulmonary function indices, and postoperative complications. Random-effects meta-analyses were applied.

Meta-analysis results showed no significant difference in LOS between lobectomy and segmentectomy (mean difference -0.20, 95% confidence interval -0.83 to 0.44; p=0.547). Operative time was significantly shorter with lobectomy (mean difference -18.45, 95% CI -27.21 to -9.68; p<0.0001). Chest tube removal time did not differ significantly between groups. Across all pulmonary function outcomes, no statistically significant differences were observed. Overall postoperative complications were similar between procedures (odds ratio 0.96, 95% CI 0.58-1.61; p=0.883).

The authors concluded that lobectomy and segmentectomy demonstrate no differences in hospital duration, complications, or pulmonary function, but lobectomy provides a shorter surgical time and diminished early air leakage without affecting overall postoperative results. The study acknowledges that all included studies were retrospective and observational, and the authors note that high-quality, prospective studies are essential for clarifying long-term outcomes to improve surgical decision-making.

For parents facing surgery for their child's congenital lung malformation, a key question is how much lung tissue needs to be removed. Surgeons have debated whether to perform a lobectomy, which removes an entire lobe of the lung, or a segmentectomy, which removes only the affected segment to preserve more healthy tissue. This review of nine studies in infants and children found that the choice doesn't appear to change the most important things for families: how long the child stays in the hospital or their overall risk of complications after surgery. The procedures also showed no difference in how long a chest tube was needed or in measures of lung function. The one clear difference was that the lobectomy surgery was, on average, about 18 minutes faster to perform. The analysis concluded that both surgical approaches lead to similar short-term results. However, the authors note that more high-quality, long-term studies are needed to fully understand if one approach is better for a child's health over many years.