Indications, Trends and Outcomes in Pediatric Lung Resections: A 12-Year Study in a Tertiary Referral Center

<b><i>Background</i></b>: Lung resections in children are rare but critical for congenital lung malformations (CLMs) and acquired pathologies; few studies have analyzed the full spectrum of indications. This study evaluated indications, complications, outcomes, and temporal trends in a tertiary pediatric center. <b><i>Methods</i></b>: We retrospectively analyzed patients who underwent lung resection (2012-2024), focusing on indications, approaches, complications, and outcomes. Comparisons between pathologies (CLMs vs. acquired pathologies), approaches (thoracoscopy vs. thoracotomy), an temporal trends were evaluated. <b><i>Results</i></b>: Among 160 patients (mean age: 7.8 years), acquired lesions (68.6%) were more common than CLMs (31.4%), predominating in children under 8 years. Compared with thoracotomy, thoracoscopy (72.8% of cases, conversion rate: 22.8%) was correlated with shorter operative times (<i>p</i> < 0.001) and hospital stays (<i>p</i> = 0.001). The complication rate was 19.5%, with 71.9% of patients achieving disease-free, asymptomatic status at follow-up. Risk factors for conversion from thoracoscopy to open surgery included intraoperative adhesions (<i>p</i> = 0.003), underlying pathology (<i>p</i> = 0.013), and age < 8 years (<i>p</i> = 0.017). Compared with acquired lesions, CLMs were associated with fewer complications (14.3% vs. 23.1%, <i>p</i> = 0.041) and more favorable outcomes (89.2% vs. 64.7%; <i>p</i> < 0.05). Over time, the use of thoracoscopy increased (<i>p</i> = 0.012), with reduced operative time (<i>p</i> = 0.005); complication and outcome rates remained stable. <b><i>Conclusions</i></b>: Pediatric lung resections address diverse pathologies; outcomes are linked to the pathology, and CLMs are associated with lower complication rates in our cohort. Thoracoscopy has progressively become the preferred approach in the last decade, offering advantages particularly in postoperative recovery, though its success depends on careful, pathology-driven patient selection.