Association of surgery and risk of long-term comorbidities for congenital lung malformations in pediatrics.

INTRODUCTION: Congenital lung malformations are increasingly recognized through prenatal and early postnatal imaging. Although many affected children are asymptomatic in infancy, CLMs are associated with long-term respiratory and structural complications. The influence of surgical timing, approach, and extent on these outcomes remains uncertain. MATERIALS AND METHODS: Using the TriNetX platform, we conducted a multicenter retrospective cohort study that included 20,101 children with CLM diagnosed before age 6 and 20,089,085 controls. Propensity score matching was applied. Asthma was the primary outcome, while recurrent infections and structural abnormalities were secondary outcomes. Subgroup analyses assessed the impact of surgical age, approach, and resection extent. RESULTS: While the primary asthma analysis did not reach statistical significance (RR 0.79, 95% CI 0.54-1.14, p=0.191), but statistical significance existed in asthma with strict definition (RR 0.22, 95% CI 0.11-0.42, p<0.001), recurrent pneumonia (RR 0.29, 95% CI 0.16-0.51, p< 0.001) and structural deformities (RR 0.54, 95% CI 0.30-0.97, p=0.039). Thoracoscopic surgery was associated with fewer selected complications than thoracotomy, particularly musculoskeletal outcomes. CONCLUSION: CLMs confer increased risks of respiratory and structural morbidity. The observational associations suggest that the clinical window of benefit may span the first two years of life.