Outcome of anatomical versus non-anatomical lung resection for necrotizing pneumonia in children

Objective: We aimed to evaluate the characteristics, complications and outcomes of necrotizing pneumonia (NP) requiring surgical intervention.

Methods: We conducted a retrospective study of all children who underwent surgical therapy for NP from January 2010 to December 2023. Patients were analyzed based on two surgical approaches: anatomic resection (AR) or non-AR (NAR).

Results: A total of 66 patients (median age: 36 months) required a surgical intervention for NP. A total of 37 patients received AR, 29 received NAR. The AR procedures were segmentectomy (n=29), lobectomy (n=8), bilobectomy (n=1) whereas NAR included wedge resection (n=13) and necrosectomy (n=16). The most common reasons for surgery were failure to respond to treatment (43.9%) and sepsis/septic shock (42.4%). A significantly greater proportion of patients in the AR group underwent surgery due to sepsis (p=0.023). There was no difference in the proportion of patients experiencing complications between the AR group (40.5%) and the NAR group (27.5%) (p=0.266). The majority of complications in both groups (68.0%) were categorized as minor, with 59.0% of cases occurring in patients who underwent AR. Prolonged air leak was the most frequent complication in both groups. There was no difference in the postoperative hospital stay, or duration of mechanical ventilation between the groups. There were no deaths.

Conclusions: Surgical intervention for NP may result in complications in one-third of patients, mostly minor and unlikely to significantly impact outcomes. Surgery should be tailored to the extent of parenchymal involvement.