Abstract
BACKGROUND: Congenital lung malformations (CLMs) are uncommon anomalies characterized by a broad clinical spectrum, from asymptomatic cases to severe respiratory distress. Surgical resection is often indicated; nevertheless, the optimal extent of resection is still debated, especially regarding lobectomy versus lung-sparing segmentectomy. OBJECTIVE: This systematic review and meta-analysis aimed to compare the efficacy and safety of lobectomy versus segmentectomy in pediatric patients with CLMs. METHODS: We searched databases, including PubMed, Scopus, Web of Science, and Cochrane, to identify papers comparing lobectomy with segmentectomy in pediatric patients with CLMs. The main outcome was the duration 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. RESULTS: Nine retrospective observational studies involving infants and children were included. Meta-analysis showed no significant difference in LOS between lobectomy and segmentectomy (MD - 0.20, 95% CI - 0.83 to 0.44; p = 0.547). Operative time was significantly shorter with lobectomy (MD - 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 (OR 0.96, 95% CI 0.58-1.61; p = 0.883). CONCLUSIONS: Lobectomy and segmentectomy demonstrate no differences in hospital duration, complications, or pulmonary function; nevertheless, lobectomy provides a shorter surgical time and diminished early air leakage without affecting overall postoperative results. High-quality, prospective studies are essential for clarifying long-term outcomes to improve surgical decision-making.