Comparing thoracoscopic anatomical lesion resection and lobectomy in children with congenital lung malformations: a multicenter retrospective cohort study.

BACKGROUND: The efficacy of thoracoscopic anatomical lesion resection (TALR) for children with congenital lung malformations (CLMs) remains controversial. This multicenter cohort study aimed to compare the perioperative outcomes of TALR and thoracoscopic lobectomy (TL) in pediatric CLM patients. METHODS: Clinical data of 1176 children with CLMs who underwent TALR (n = 692) or TL (n = 484) in 6 Chinese hospitals from January 2020 to December 2024 were analyzed. Propensity score matching (PSM) was used to adjust for confounding factors, and the effect of indocyanine green (ICG) navigation in the TALR subgroup was evaluated. RESULTS: After PSM, 968 patients (484 in each group) were included in the analysis. There were significant variations in surgical volume and approach across centers, with TALR being increasingly preferred over time. Pre-matching differences in age and weight between the two groups were eliminated after PSM. In the matched cohort, no significant differences were observed in postoperative complication rates, reoperation rates, or conversion rates to open thoracotomy between the two groups. However, TALR was significantly associated with a significant prolongation of postoperative hospital stay, and the number of cases with chest tube placement was higher. Within the TALR cohort, patients who received ICG demonstrated superior outcomes, reduced operative time and shorter post-operative hospital stay. CONCLUSIONS: TALR is a safe and effective lung-sparing alternative to TL for pediatric CLMs with comparable safety profiles. ICG navigation enhances TALR precision and improves perioperative outcomes, and standardized training is essential for its promotion.