Impact of prior pulmonary infection on surgical outcomes in pediatric pulmonary sequestration: a multicenter retrospective study from the East Asia Pediatric Surgery Research Consortium.

PURPOSE: This study aims to compare the clinical and surgical characteristics of intralobar (IPS) and extralobar (EPS) pulmonary sequestration, with focus on the impact of prior pulmonary infection on IPS. METHODS: This retrospective multicenter study included pediatric patients with pulmonary sequestration who underwent surgery between 2005 and 2024 at four institutions in Hong Kong and Japan. Patients with hybrid lesions were excluded. Multivariable logistic regression and inverse probability of treatment weighting (IPTW) were performed in the IPS subgroup. RESULTS: Among 133 patients (73 IPS, 60 EPS), IPS had higher prior infection rates (27.4% vs. 3.3%, p < 0.01), required lobectomy more frequently (63.0% vs. 0%, p < 0.001), and showed longer operative time (182 vs. 75 min, p < 0.001) than EPS. After IPTW adjustment, prior infection remained associated with longer operative time (+ 92.9 min, p = 0.002) and a trend toward increased lobectomy (OR 6.85, p = 0.089). Early postoperative complications were comparable. CONCLUSION: IPS showed greater operative complexity than EPS, primarily driven by prior infection and the need for lobectomy. Early elective resection before infection develops may reduce operative complexity while maintaining surgical safety.