Endobronchial Hamartoma: A Retrospective Cohort Study of 17 Cases and Systematic Review of the Contemporary Literature

Background: Endobronchial hamartoma (EBH) is an exceptionally rare benign neoplasm frequently misdiagnosed as an obstructive malignancy. The therapeutic paradigm is shifting from traditional anatomical resection toward parenchyma-preserving interventional techniques. This study evaluates the efficacy and safety profiles of contemporary bronchoscopic interventions versus surgical management for EBH. Methods: A retrospective analysis was conducted on a clinical cohort of 17 patients treated between 2013 and 2026, alongside a comprehensive systematic review of 31 contemporary studies (2013–2025). The primary endpoint was the treatment success rate at 3 months, while secondary outcomes included perioperative complications, re-intervention rates, and successful lung parenchyma preservation. Results: Within the analyzed cohort (median age, 58 years), lesions exhibited a significant right-sided predilection (70.6%). Preoperative imaging uniformly revealed non-specific masses, with 41.2% displaying secondary obstructive manifestations. Definitive interventions comprised bronchoscopic management (n = 11, 64.7%) and surgical resection (n = 6, 35.3%). The technical success rate was 100%, with zero major perioperative complications and only minimal-to-scant intraoperative bleeding reported. Over a median follow-up of 3 months, local recurrence was observed in three cases (17.6%)—notably spanning both surgical (n = 2) and bronchoscopic (n = 1) modalities. The systematic review corroborated these findings, underscoring the exemplary safety profile and superior lung-sparing capacity of bronchoscopic interventions. Conclusions: Within the limits of this retrospective cohort and literature review, interventional bronchoscopy appears to be a safe and lung-sparing approach. It may be considered as a preferable initial treatment option for anatomically suitable EBHs. Traditional surgical resection remains necessary for anatomically complex lesions or cases with irreversible distal parenchymal destruction. Vigilant longitudinal surveillance is advised across all modalities.