Clinical Features and Outcomes of Adult Congenital Pulmonary Airway Malformation: A 47-Case Retrospective Study

Clinical Features and Outcomes of Adult Congenital Pulmonary Airway Malformation: A 47-Case Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Features and Outcomes of Adult Congenital Pulmonary Airway Malformation: A 47-Case Retrospective Study Defeng Luo, Weixun Zhang, Xiangyue Liao, Chaoyang Liang, Weijie Zhu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7481323/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background Congenital pulmonary airway malformation (CPAM) is a rare developmental anomaly of the lung that is predominantly diagnosed in infancy, whereas adult cases remain uncommon. Comprehensive evidence regarding clinical characteristics, surgical management, and long-term outcomes in adults is limited. Methods We retrospectively reviewed 47 adult patients with pathologically confirmed CPAM who underwent surgical resection at a single tertiary center from 2012 to 2025. Clinical data, radiologic features, operative details, pathological findings, and follow-up outcomes were analyzed. Subgroup analyses were performed according to age and preoperative respiratory infection status. Results The cohort included 20 males and 27 females with a median age of 44 years. Common lesion sites were the left lower lobe (31.9%) and right lower lobe (36.2%). Nineteen patients (40.4%) underwent sublobectomy and 28 (59.6%) lobectomy. Preoperative infection occurred in 17 patients (36.2%), who exhibited more respiratory symptoms, lower pulmonary function, longer operative times, and prolonged chest drainage compared with non-infected patients (all p < 0.05). Younger patients presented more frequently with infections and larger lesions, and lobectomy was more commonly performed in this group. Postoperative complications were infrequent, with no perioperative mortality. During follow-up, 85.1% of patients reported preserved physical strength and activity tolerance. Pathology revealed concomitant pulmonary lesions in 18 cases (38.3%), including one mucinous adenocarcinoma. Conclusions Adult CPAM exhibits heterogeneous clinical manifestations and is frequently complicated by infection or other pulmonary diseases. Surgical resection is safe and effective, providing favorable long-term functional recovery. Personalized surgical planning is essential, and more studies are required to refine management strategies. congenital pulmonary airway malformation congenital lung disease adult surgery outcomes INTRODUCTION Congenital cystic adenomatoid malformation (CCAM), more recently termed congenital pulmonary airway malformation (CPAM), is a rare developmental anomaly of the distal airways and represents the most common form of congenital cystic lung disease[ 1 , 2 ]. The term “CCAM” was first introduced by Stocker et al. in 1977, who classified the lesions into three histological types (I–III) according to cyst size and morphology[ 3 ]. In 2002, Stocker expanded the classification to five subtypes (I–V) and introduced the term “CPAM” to better reflect the airway origin of the malformation and to recognize that not all cases are predominantly cystic or adenomatoid[ 4 ]. Although CPAM is typically diagnosed during the perinatal or pediatric period, adult cases are rare, and the true incidence is likely underestimated due to asymptomatic presentation or misdiagnosis[ 5 , 6 ]. With the widespread application of computed tomography (CT), an increasing number of adult CPAM cases are being detected preoperatively[ 7 ]. In adults, clinical manifestations range from completely asymptomatic to nonspecific respiratory symptoms, including recurrent pulmonary infections, hemoptysis, chest discomfort, or spontaneous pneumothorax[ 8 , 9 ]. Radiologically, CPAM lesions may appear as unilocular or multilocular cysts, cavitary lesions, or mixed cystic–solid masses, and can occasionally mimic bronchiectasis, lung abscess, or malignancy[ 1 ]. Recent studies have emphasized that adult CPAM may coexist with other pulmonary abnormalities, including pulmonary sequestration, chronic infection, and malignant tumors such as adenocarcinoma in situ, mucinous adenocarcinoma, and carcinoid tumors[ 10 ]. These findings underscore the importance of thorough histopathological evaluation after resection. Given the risks of recurrent infection, progressive lung damage, and malignant transformation, surgical resection is recommended as the treatment of choice for adult CPAM, even in asymptomatic patients. The extent of resection, including lobectomy or segmentectomy, is determined by the size and location of the lesion[ 2 , 11 ]. However, despite an increasing number of case reports and small series[ 12 ], large-scale cohort studies systematically summarizing the clinical spectrum, radiologic features, pathological subtypes, and surgical outcomes in adults remain scarce. In this study, we retrospectively reviewed 47 adult patients with pathologically confirmed CPAM who underwent surgical resection at our hospital, aiming to provide updated evidence on their demographic characteristics, imaging findings, operative details, pathological features, and follow-up outcomes. Furthermore, patients were stratified into young/adult and middle-to-older age groups, and by the presence or absence of preoperative respiratory infection, to explore subgroup differences and evaluate whether these factors influence clinical presentation, pathological features, and surgical prognosis. METHODS Study population We retrospectively collected clinical data from adult patients who underwent surgical resection and were pathologically diagnosed with congenital pulmonary airway malformation (CPAM) at the Department of Thoracic Surgery, China-Japan Friendship Hospital, between February 2012 and February 2025. The diagnosis of CPAM was independently confirmed by two experienced pathologists based on hematoxylin–eosin staining results. Inclusion criteria were as follows: (I) age ≥ 18 years at diagnosis; (II) pathologically confirmed CPAM following surgical resection; and (III) complete clinical, imaging, operative, and pathological records. Exclusion criteria included: (I) age < 18 years; (II) histology inconsistent with CPAM; and (III) incomplete clinical or follow-up data. This study was conducted in accordance with the Declaration of Helsinki (as revised in 2013), and ethical approval was obtained from the Clinical Research Ethics Committee of the hospital. The requirement for individual informed consent was waived due to the retrospective nature of the study. Data collection Clinical data for all patients were retrospectively collected from the institutional electronic medical record system and surgical database. Variables included: (I) demographic characteristics (sex, age, and body mass index [BMI]); (II) clinical presentation (disease onset time, primary symptoms such as dry cough, productive cough, and fever, preoperative respiratory tract infection status, family history, and smoking history); (III) radiological and pathological features (lesion location, size, morphology, and coexisting lesions such as sequestration, infection, or neoplasia); (IV) laboratory tests (white blood cell count, neutrophil count, neutrophil-to-WBC ratio, forced expiratory volume in 1 second [FEV₁], and diffusing capacity for carbon monoxide [DLCO]); (V) preoperative assessment (American Society of Anesthesiologists [ASA] physical status classification); (VI) surgical information (surgical procedure, operative duration, conversion to thoracotomy, estimated intraoperative blood loss, and other relevant intraoperative details); (VII) postoperative course (length of hospital stay, duration of chest tube drainage, postoperative fever, reoperation, and readmission during follow-up); and (VIII) long-term physical activity tolerance, which was evaluated through telephone follow-up. Surgical procedures All surgeries were performed by thoracic surgeons using video-assisted thoracoscopic surgery (VATS). Conversion to open thoracotomy was determined by intraoperative findings. Resected specimens were examined both macroscopically and microscopically, with representative sections obtained from the capsule wall, solid areas, and any suspicious lesions. A chest drainage tube was placed in each patient postoperatively. The tube was removed when the daily drainage volume was less than 200 mL and no significant air leak was observed, and a chest X-ray was performed to confirm adequate lung expansion. Statistical analysis Statistical analyses were performed using R software (version 4.4.3). Continuous variables are presented as medians with interquartile ranges, while categorical variables are expressed as frequencies and percentages. A two-sided p-value less than 0.05 was considered statistically significant. RESULTS A total of 47 patients with pathologically confirmed CPAM were included in this study. Table 1 summarizes baseline characteristics. Among them, 20 cases (42.6%) were males and 27 cases (57.4%) were females; 17 patients (36.2%) had preoperative respiratory tract infection, and 30 (63.8%) did not. Nineteen patients (40.4%) underwent sublobectomy and 28 patients (59.6%) underwent lobectomy; the lesions were most commonly located in the left lower lobe (31.9%) and right lower lobe (36.2%). In addition, 27 patients (57.4%) had different degrees of pleural adhesions, 1 patient switched from thoracoscopic surgery to thoracotomy during surgery, 7 patients (14.9%) had fever after surgery, and 1 patient was readmitted to the hospital for treatment. At the last follow-up, 40 patients (85.1%) reported no significant abnormalities in physical strength and activity tolerance, and 7 patients (14.9%) showed a decrease in physical strength and activity tolerance. The final postoperative pathology showed that 18 cases of CPAM were mixed with other diseases (6 cases of pulmonary bullae, 6 cases of pulmonary fungal disease, 3 cases of pulmonary abscess, 1 case of pulmonary sequestration, 1 case of mucinous adenocarcinoma, and 1 case of thymic cyst). No patients died during or after surgery. Table 1 Clinical characteristics of the patients. Variables [ 1 ] Value (n = 47) Gender female 27 (57.4) male 20 (42.6) Age (year) 48.00 [33.00, 58.00] BMI 23.38 [22.04, 25.92] CT size (cm) 5.70 [4.00, 8.25] Pathological size (cm) 4.00 [2.50, 6.50] Lesion morphology unilocular 24 (51.1) multilocular 23 (48.9) Location LUL 5 (10.6) LLL 15 (31.9) RUL 5 (10.6) RML 5 (10.6) RLL 17 (36.2) Diabetes Mellitus 4 (8.5) Asthma 1 (2.1) Hypertension 7 (14.9) Preoperative respiratory infection 17 (36.2) Postoperative hospital stay (day) 5.00 [4.00, 6.00] Symptom duration (month) 5.00 [1.00, 24.00] Dry cough 22 (46.8) Fever 9 (19.1) Productive cough 17 (36.2) Family history 1 (2.1) Smoking 9 (19.1) Cardiovascular comorbidity 4 (8.5) White blood cell count (×10⁹/L) 5.97 [4.71, 7.54] Neutrophil count (×10⁹/L) 3.40 [2.45, 4.28] Neutrophil-to-lymphocyte ratio 0.57 [0.50, 0.61] FEV1 (% predicted) 92.10 [82.70, 105.25] DLCO (% predicted) 80.70 [70.40, 90.00] ASA grade II 40 (88.9) grade III 5 (11.1) Operative time (h) 1.67 [1.38, 2.50] Pleural adhesions 27 (57.4) Postoperative fever 7 (14.9) Reoperation 0 (0.0) Readmission 1 (2.1) Duration of tube placement(day) 3.00 [3.00, 5.00] Intraoperative bleeding(ml) 20.00 [15.00, 50.00] Transfusion (ml) 0 (0.0) Conversion to open 1 (2.1) Surgical Procedures sublobar resection 19 (40.4) lobectomy 28 (59.6) Postoperative pathology CPAM 29 (61.7) CPAM + PS 1 (2.1) CPAM + LA 3 (6.4) CPAM + PFD 6 (12.8) CPAM + LC 1 (2.1) CPAM + PB 6 (12.8) CPAM + TC 1 (2.1) Long-term exercise tolerance preserved 40 (85.1) reduced 7 (14.9) [ 1 ]: Continuous data are expressed as median (interquartile range) and categorical data are expressed as numbers (percentages).BMI: body mass index; CT: computed tomography; RUL: right upper lobe; RML: right middle lobe; RLL: right lower lobe; LUL: left upper lobe; LLL: left lower lobe; FEV1: forced expiratory volume in 1 second; DLCO: diffusing capacity for carbon monoxide; ASA: American Society of Anesthesiologists physical status classification; PS: pulmonary sequestration; LA: lung abscess; PFD: pulmonary fungal disease; LC: lung cancer; PB: pulmonary bullae; TC: thymic cyst; CPAM: congenital pulmonary airway malformation. Based on the natural course of CPAM and the risk of age-related complications, we stratified all patients using 45 years of age as the cutoff point, with 21 patients assigned to the younger group and 26 patients assigned to the older group. A comparison between the two groups revealed statistically significant differences in the following variables (Table 2 ): the incidence of preoperative respiratory tract infections was higher in younger patients (57.1% vs. 19.2%, p = 0.017). Additionally, the maximum lesion diameter measured by preoperative imaging (p < 0.001) and pathological examination (p < 0.001) was significantly larger in the younger group than in the older group. Pulmonary function test results showed that DLCO values were higher in older patients than in younger patients (p = 0.008). Regarding surgical procedures, lobectomy was more commonly performed in the younger group, while segmentectomy was more commonly performed in the older group (p = 0.003). Table 2 Comparison of Clinical Characteristics Between Younger and Older Patient Groups. Variables [ 1 ] younger group (< 45 years) older group (≥ 45 years) P -value Gender 0.394 female 14 (66.7) 13 (50.0) male 7 (33.3) 13 (50.0) BMI 22.48 [20.96, 24.15] 23.95 [22.80, 26.16] 0.054 CT size (cm) 8.00 [6.15, 10.60] 4.40 [2.80, 5.92] < 0.001 Pathological size (cm) 6.40 [4.00, 9.40] 3.00 [2.20, 4.00] < 0.001 Lesion morphology unilocular 9 (42.9) 15 (57.7) 0.473 multilocular 12 (57.1) 11 (42.3) Location 0.082 LUL 0 (0.0) 5 (19.2) LLL 7 (33.3) 8 (30.8) RUL 1 (4.8) 4 (15.4) RML 4 (19.0) 1 (3.8) RLL 9 (42.9) 8 (30.8) Diabetes Mellitus 1 (4.8) 3 (11.5) 0.763 Asthma 1 (4.8) 0 (0.0) 0.914 Hypertension 1 (4.8) 6 (23.1) 0.180 Preoperative respiratory infection 12 (57.1) 5 (19.2) 0.017 Postoperative hospital stay (day) 4.00 [4.00, 6.00] 5.00 [4.00, 6.00] 0.931 Symptom duration (month) 6.00 [2.00, 12.00] 4.50 [1.00, 24.00] 0.755 Dry cough 12 (57.1) 10 (38.5) 0.326 Fever 7 (33.3) 2 (7.7) 0.065 Productive cough 9 (42.9) 8 (30.8) 0.581 Family history 0 (0.0) 1 (3.8) 1.000 Smoking 3 (14.3) 6 (23.1) 0.698 Cardiovascular comorbidity 0 (0.0) 4 (15.4) 0.176 White blood cell count (×10⁹/L) 5.97 [4.71, 6.96] 5.99 [4.76, 7.80] 0.716 Neutrophil count (×10⁹/L) 3.24 [2.38, 3.69] 3.41 [2.50, 4.80] 0.320 Neutrophil-to-lymphocyte ratio 0.54 [0.48, 0.59] 0.58 [0.51, 0.63] 0.083 FEV1 (% predicted) 91.10 [83.00, 96.40] 97.40 [81.45, 112.32] 0.171 DLCO (% predicted) 73.20 [69.30, 80.70] 86.60 [74.88, 95.17] 0.008 ASA 0.557 grade II 18 (94.7) 22 (84.6) grade III 1 (5.3) 4 (15.4) Operative time (h) 1.92 [1.50, 2.50] 1.59 [1.25, 2.56] 0.346 Pleural adhesions 12 (57.1) 15 (57.7) 1.000 Postoperative fever 4 (19.0) 3 (11.5) 0.759 Reoperation 0 0 - Readmission 1 (4.8) 0 (0.0) 0.914 Duration of tube placement(day) 3.00 [3.00, 4.00] 3.00 [2.00, 5.00] 0.584 Intraoperative bleeding(ml) 20.00 [20.00, 50.00] 20.00 [12.50, 87.50] 0.810 Transfusion (ml) 0.00 [0.00, 0.00] 0.00 [0.00, 0.00] 0.369 Conversion to open 1 (4.8) 0 (0.0) 0.914 Surgical Procedures 0.003 sublobar resection 3 (14.3) 16 (61.5) lobectomy 18 (85.7) 10 (38.5) Postoperative pathology 0.782 with coexisting lesions 9 (42.9) 9 (34.6) without coexisting lesions 12 (57.1) 17 (65.4) Long-term exercise tolerance 0.605 preserved 19 (90.5) 21 (80.8) reduced 2 (9.5) 5 (19.2) [ 1 ]: Continuous data are expressed as median (interquartile range) and categorical data are expressed as numbers (percentages). BMI: body mass index; CT: computed tomography; RUL: right upper lobe; RML: right middle lobe; RLL: right lower lobe; LUL: left upper lobe; LLL: left lower lobe; FEV1: forced expiratory volume in 1 second; DLCO: diffusing capacity for carbon monoxide; ASA: American Society of Anesthesiologists physical status classification. We also categorized patients based on their preoperative respiratory tract infection status into an infection group (n = 17) and a non-infection group (n = 30) (Table 3 ). Patients with preoperative infections were more likely to exhibit respiratory symptoms such as dry cough (p = 0.006) and fever (p = 0.012). Additionally, the DLCO values in the infection group were significantly lower than those in the non-infection group (p = 0.040). In terms of surgical procedures, patients without infection were more likely to undergo sublobar resection, while those with infection were more likely to undergo lobectomy (p = 0.037). The infection group also had significantly longer surgical times (p < 0.001), and the post-operative chest tube drainage duration was significantly longer in the infection group compared to the non-infection group (p < 0.033). Table 3 Comparison of Clinical Characteristics Between Patients With and Without Preoperative Respiratory Tract Infection Variables [ 1 ] non-infection group infection group P -value Gender 0.870 female 18 (60.0) 9 (52.9) male 12 (40.0) 8 (47.1) BMI 23.52 [22.24, 25.84] 23.31 [21.51, 25.71] 0.479 CT size (cm) 5.20 [3.47, 8.15] 6.15 [4.80, 8.30] 0.245 Pathological size (cm) 3.90 [2.35, 6.47] 4.00 [2.50, 8.50] 0.527 Lesion morphology 0.913 unilocular 16 (53.3) 8 (47.1) multilocular 14 (46.7) 9 (52.9) Location 0.363 LUL 5 (16.7) 0 (0.0) LLL 10 (33.3) 5 (29.4) RUL 2 (6.7) 3 (17.6) RML 3 (10.0) 2 (11.8) RLL 10 (33.3) 7 (41.2) Diabetes Mellitus 3 (10.0) 1 (5.9) 1.000 Asthma 1 (3.3) 0 (0.0) 1.000 Hypertension 6 (20.0) 1 (5.9) 0.379 Age (year) 52.50 [37.50, 59.00] 36.00 [31.00, 45.00] 0.111 Postoperative hospital stay (day) 4.00 [3.25, 5.75] 5.00 [4.00, 7.00] 0.071 Symptom duration (month) 2.00 [1.00, 21.00] 7.00 [3.00, 24.00] 0.168 Dry cough 9 (30.0) 13 (76.5) 0.006 Fever 2 (6.7) 7 (41.2) 0.012 Productive cough 8 (26.7) 9 (52.9) 0.137 Family history 0 (0.0) 1 (5.9) 0.771 Smoking 4 (13.3) 5 (29.4) 0.337 Cardiovascular comorbidity 3 (10.0) 1 (5.9) 1.000 White blood cell count (×10⁹/L) 5.71 [4.49, 7.48] 6.38 [5.53, 7.62] 0.358 Neutrophil count (×10⁹/L) 3.23 [2.39, 3.99] 3.69 [2.99, 4.39] 0.388 Neutrophil-to-lymphocyte ratio 0.58 [0.50, 0.61] 0.55 [0.53, 0.63] 0.842 FEV1 (% predicted) 92.50 [81.45, 105.27] 88.30 [83.00, 99.90] 0.587 DLCO (% predicted) 84.70 [74.88, 93.60] 73.20 [68.00, 89.10] 0.040 ASA 1.000 grade II 27 (90.0) 13 (86.7) grade III 3 (10.0) 2 (13.3) Operative time (h) 1.50 [1.21, 1.79] 2.58 [2.09, 3.25] < 0.001 Pleural adhesions 15 (50.0) 12 (70.6) 0.287 Postoperative fever 3 (10.0) 4 (23.5) 0.409 Reoperation 0 (0.0) 0 (0.0) - Readmission 0 (0.0) 1 (5.9) 0.771 Duration of tube placement(day) 3.00 [2.00, 4.00] 4.00 [3.00, 5.00] 0.033 Intraoperative bleeding(ml) 20.00 [10.00, 45.00] 50.00 [20.00, 100.00] 0.107 Transfusion (ml) 0.00 [0.00, 0.00] 0.00 [0.00, 0.00] 0.452 Conversion to open 1 (3.3) 0 (0.0) 1.000 Surgical Procedures 0.037 sublobar resection 16 (53.3) 3 (17.6) lobectomy 14 (46.7) 14 (82.4) Postoperative pathology 1.000 with coexisting lesions 11 (36.7) 7 (41.2) without coexisting lesions 19 (63.3) 10 (58.8) Long-term exercise tolerance 1.000 preserved 26 (86.7) 14 (82.4) reduced 4 (13.3) 3 (17.6) [ 1 ]: Continuous data are expressed as median (interquartile range) and categorical data are expressed as numbers (percentages). BMI: body mass index; CT: computed tomography; RUL: right upper lobe; RML: right middle lobe; RLL: right lower lobe; LUL: left upper lobe; LLL: left lower lobe; FEV1: forced expiratory volume in 1 second; DLCO: diffusing capacity for carbon monoxide; ASA: American Society of Anesthesiologists physical status classification. DISCUSSION CPAM is a rare congenital malformation of the lung, most commonly detected by prenatal ultrasound, with only a minority of cases identified in adulthood[ 13 , 14 ]. Patients with CPAM may present with respiratory symptoms such as cough, recurrent infections, or, in severe cases, respiratory failure[ 15 ]. Surgical resection remains the standard treatment for symptomatic CPAM, and prophylactic resection is also frequently recommended for asymptomatic patients to reduce the risks of recurrent infection and malignant transformation[ 16 , 17 ]. In this retrospective study of 47 adult patients with pathologically confirmed CPAM, we found that age and preoperative infection status significantly influenced clinical presentation, surgical approach, and perioperative outcomes. Younger patients were more likely to present with preoperative respiratory infections and larger lesions, supporting the rationale for earlier surgical intervention. In contrast, older patients, who often remain asymptomatic and undiagnosed for extended periods, tended to undergo surgery at a more advanced stage. Patients with preoperative infections demonstrated more severe respiratory symptoms, reduced pulmonary function, longer operative times, prolonged chest tube drainage, and a higher likelihood of requiring lobectomy. Moreover, more than one-third of cases were complicated by other pulmonary conditions, including one case of mucinous adenocarcinoma, underscoring the heterogeneity and malignant potential of adult CPAM. Notably, long-term follow-up demonstrated that most patients achieved favorable functional recovery, with preservation of physical strength and exercise tolerance. Our findings are consistent with previous large-scale studies of adult CPAM. Zeng et al. analyzed adult patients and reported that recurrent respiratory infections and pneumonia were common, but that the disease was also frequently detected incidentally during imaging examinations for other conditions, highlighting the diverse clinical presentation of CPAM[ 1 ]. Case reports further suggest that early surgical resection in adults is both safe and effective, with curative outcomes achieved in many instances[ 18 ]. Similarly, in our study, perioperative outcomes were favorable, with no surgical deaths and only one patient requiring conversion to thoracotomy. Importantly, patients with preoperative infections experienced greater surgical difficulty and delayed recovery, which aligns with previous reports suggesting that infection and inflammation contribute to thickened adhesions, tissue edema, and increased surgical complexity[ 1 ]. Another important finding of this study was the high prevalence of concomitant pulmonary lesions. Notably, 6 patients developed fungal infections within CPAM lesions. The structural abnormalities of CPAM, such as impaired drainage and mucus retention, provide a favorable environment for opportunistic fungi. Such infections may exacerbate respiratory symptoms, lead to persistent inflammation, and cause dense pleural adhesions, thereby increasing operative difficulty. Surgical resection in these cases not only addresses the congenital malformation but also eradicates the fungal focus, which is often difficult to control with antifungal therapy alone[ 19 ]. In addition to infection, the identification of mucinous adenocarcinoma within a CPAM lesion in our cohort underscores the malignant potential of this anomaly. Previous studies have reported somatic KRAS mutations in CPAM-associated adenocarcinomas, and DICER1 mutations have been linked to CPAM type 4 and pleuropulmonary blastoma[ 6 , 20 ]. Taken together, these findings emphasize the necessity of complete surgical excision, meticulous histopathological evaluation, and long-term surveillance, even in asymptomatic adult patients. Surgical decision-making in adult CPAM requires comprehensive consideration of multiple factors. Sublobar resection is increasingly favored for its parenchyma-sparing advantages, particularly in older patients where preservation of lung function is a priority. In contrast, for younger patients with larger lesions or those with preoperative infections, complete resection through lobectomy may be more appropriate to ensure surgical safety and oncological completeness. Our study reflects this clinical reality: sublobar resections were more commonly performed in older patients, whereas lobectomies were more frequent among younger and infected patients. These observations underscore the necessity of developing individualized surgical strategies that incorporate patient age, lung function, infection status, and lesion characteristics, rather than applying a uniform surgical approach. Long-term follow-up in our cohort further supports the safety and benefits of surgical resection. At the final follow-up, 85.1% of patients reported no decline in physical strength or exercise tolerance, and no perioperative or follow-up deaths occurred, with only one patient requiring readmission. These favorable outcomes indicate that surgical resection not only alleviates symptoms and prevents recurrent infections but also preserves long-term quality of life[ 21 ]. The inclusion of functional follow-up data provides additional evidence confirming both the safety and the sustained benefits of surgery for adult CPAM. This study has several limitations that should be acknowledged. First, it was a single-center retrospective analysis, and selection bias cannot be excluded. Only patients undergoing surgical resection were included, which may underestimate the prevalence of asymptomatic or mildly symptomatic adults with CPAM and does not reflect the full natural history of the disease. Second, although the sample size of 47 patients is moderate compared with prior series, it remains relatively small and insufficient for robust subgroup analyses, limiting the generalizability of our findings. Third, perioperative and follow-up data were primarily derived from medical records and telephone interviews. Long-term outcomes were assessed mainly through subjective measures of functional recovery, such as physical strength and exercise tolerance, without systematic imaging or pulmonary function testing, which may underestimate silent recurrences or late complications. Fourth, although one case of mucinous adenocarcinoma was observed, molecular and genetic analyses were not performed, limiting further insights into the oncogenic mechanisms of CPAM. Finally, the absence of a non-surgical control group prevents direct comparisons between surgical and conservative management and precludes assessment of the optimal timing of intervention. These limitations highlight the need for larger, multicenter, prospective studies that incorporate functional, radiological, and molecular data to refine surgical indications and optimize long-term management strategies. In summary, this study highlights the heterogeneity of adult CPAM and emphasizes the influence of age and preoperative infection status on clinical presentation, surgical decision-making, and perioperative outcomes. For younger patients with larger or infected lesions, lobectomy should be prioritized to ensure surgical completeness and safety, whereas in older patients, preservation of lung function should be a key consideration. Importantly, our follow-up data demonstrate favorable long-term outcomes, supporting the role of surgical resection in the management of adult CPAM. Collectively, these findings provide new evidence to guide personalized surgical strategies and long-term management of this rare disease. CONCLUSION This study indicates that adult CPAM requires personalized surgical management. Surgical intervention remains the optimal treatment approach, ensuring symptom relief and long-term functional preservation. Additionally, the presence of concomitant pulmonary diseases should be carefully considered in surgical planning. Future studies should further clarify surgical indications. Declarations Author information Authors and Affiliations Department of General Thoracic Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing, 100029, China. China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China. Defeng Luo, Weixun Zhang, Xiangyue Liao, Chaoyang Liang, Weijie Zhu Contributions W.Z. conceived and designed the study. D.L. was involved in data acquisition and wrote the manuscript. X.L., W.Z. and C.L. analyzed the data. W.Z. revised the manuscript. All authors read and approved the final manuscript. Corresponding author: Correspondence to Weijie Zhu . Ethics declarations Ethics approval and consent to participate All procedures adhered to the principles outlined in the Declaration of Helsinki. The study protocol and related documents were approved by the Clinical Research Ethics Committee of China-Japan Friendship Hospital and the need for informed consent was waived. Consent for publication Not Applicable Competing interests The authors declare no competing interests. Funding Statement: This work was supported by the National High Level Hospital Clinical Research Funding, and the Special Fund (2060204) of the State Key Laboratory of Respiratory Health and Multimorbidity (2024-QZZZ-05), the Elite Medical Professionals Project of China-Japan Friendship Hospital (ZRJY2023-QM34). Author Contribution W.Z. conceived and designed the study. D.L. was involved in data acquisition and wrote the manuscript. X.L., W.Z. and C.L. analyzed the data. W.Z. revised the manuscript. All authors read and approved the final manuscript. Acknowledgements Not applicable. Data Availability The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. References Zeng Z, Liu C, Liu C, Pu Q, Mei J, Liao H et al. Clinical characteristics and surgical treatment of congenital cystic adenomatoid malformation in adults: the largest cohort of 46 patients . Ann Transl Med 2022; 10 :596. MacSweeney F, Papagiannopoulos K, Goldstraw P, Sheppard MN, Corrin B, Nicholson AG. An assessment of the expanded classification of congenital cystic adenomatoid malformations and their relationship to malignant transformation . Am J Surg Pathol 2003; 27 :1139-46. Stocker JT, Madewell JE, Drake RM. Congenital cystic adenomatoid malformation of the lung. Classification and morphologic spectrum . Hum Pathol 1977; 8 :155-71. Stocker JT. Congenital Pulmonary Airway Malformation—A New Name for and an Expanded Classification of Congenital Cystic Adenomatoid Malformation of the Lung . 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Association between Congenital Lung Malformations and Lung Tumors in Children and Adults: A Systematic Review . J Thorac Oncol 2016; 11 :1837-45. Luján M, Bosque M, Mirapeix RM, Marco MT, Asensio O, Domingo C. Late-onset congenital cystic adenomatoid malformation of the lung. Embryology, clinical symptomatology, diagnostic procedures, therapeutic approach and clinical follow-up . Respiration 2002; 69 :148-54. Aljarad B, Alkhayer I, Alturk A, Qatleesh S, Bara A. A rare case of congenital pulmonary airway malformation in a 14-year-old male presenting with spontaneous pneumothorax . Ann Med Surg (Lond) 2021; 68 :102692. Wong KKY, Flake AW, Tibboel D, Rottier RJ, Tam PKH. Congenital pulmonary airway malformation: advances and controversies . Lancet Child Adolesc Health 2018; 2 :290-97. Markou GA, Dafereras G, Poncelet C. Congenital Cystic Adenomatoid Malformation Diagnosed During First-Trimester Ultrasound Scan . Am J Case Rep 2018; 19 :1-4. van Horik C, Zuidweg MJP, Boerema-de Munck A, Buscop-van Kempen M, Brosens E, Vahrmeijer AL et al. Selection of potential targets for stratifying congenital pulmonary airway malformation patients with molecular imaging: is MUC1 the one? Eur Respir Rev 2023; 32 . Morini F, Zani A, Conforti A, van Heurn E, Eaton S, Puri P et al. Current Management of Congenital Pulmonary Airway Malformations: A "European Pediatric Surgeons' Association" Survey . Eur J Pediatr Surg 2018; 28 :1-5. Lo AY, Jones S. Lack of consensus among Canadian pediatric surgeons regarding the management of congenital cystic adenomatoid malformation of the lung . J Pediatr Surg 2008; 43 :797-9. Valentin M, Sharma R, Trabanco J, Ashby T. Congenital Pulmonary Airway Malformation in an Adult Male Presenting With Hemoptysis . Cureus 2022; 14 :e20862. Jaggi TK, Agarwal R, Tiew PY, Shah A, Lydon EC, Hage CA et al. Fungal lung disease . Eur Respir J 2024; 64 . Brcic L, Fakler F, Eidenhammer S, Thueringer A, Kashofer K, Kulka J et al. Pleuropulmonary blastoma type I might arise in congenital pulmonary airway malformation type 4 by acquiring a Dicer 1 mutation . Virchows Arch 2020; 477 :375-82. Shanmugam G. Adult congenital lung disease . Eur J Cardiothorac Surg 2005; 28 :483-9. Additional Declarations No competing interests reported. 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07:27:51","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":118667,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7481323/v1/17635a36119aff85213d906c.html"},{"id":93909473,"identity":"fd9b2e08-766f-494d-a8e4-e769160855b8","added_by":"auto","created_at":"2025-10-20 07:43:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3822482,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7481323/v1/3b4d8a55-015a-4ec3-8a99-3a93b041ac75.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical Features and Outcomes of Adult Congenital Pulmonary Airway Malformation: A 47-Case Retrospective Study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eCongenital cystic adenomatoid malformation (CCAM), more recently termed congenital pulmonary airway malformation (CPAM), is a rare developmental anomaly of the distal airways and represents the most common form of congenital cystic lung disease[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The term \u0026ldquo;CCAM\u0026rdquo; was first introduced by Stocker et al. in 1977, who classified the lesions into three histological types (I\u0026ndash;III) according to cyst size and morphology[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In 2002, Stocker expanded the classification to five subtypes (I\u0026ndash;V) and introduced the term \u0026ldquo;CPAM\u0026rdquo; to better reflect the airway origin of the malformation and to recognize that not all cases are predominantly cystic or adenomatoid[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough CPAM is typically diagnosed during the perinatal or pediatric period, adult cases are rare, and the true incidence is likely underestimated due to asymptomatic presentation or misdiagnosis[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. With the widespread application of computed tomography (CT), an increasing number of adult CPAM cases are being detected preoperatively[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In adults, clinical manifestations range from completely asymptomatic to nonspecific respiratory symptoms, including recurrent pulmonary infections, hemoptysis, chest discomfort, or spontaneous pneumothorax[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRadiologically, CPAM lesions may appear as unilocular or multilocular cysts, cavitary lesions, or mixed cystic\u0026ndash;solid masses, and can occasionally mimic bronchiectasis, lung abscess, or malignancy[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Recent studies have emphasized that adult CPAM may coexist with other pulmonary abnormalities, including pulmonary sequestration, chronic infection, and malignant tumors such as adenocarcinoma in situ, mucinous adenocarcinoma, and carcinoid tumors[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. These findings underscore the importance of thorough histopathological evaluation after resection.\u003c/p\u003e\u003cp\u003eGiven the risks of recurrent infection, progressive lung damage, and malignant transformation, surgical resection is recommended as the treatment of choice for adult CPAM, even in asymptomatic patients. The extent of resection, including lobectomy or segmentectomy, is determined by the size and location of the lesion[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, despite an increasing number of case reports and small series[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], large-scale cohort studies systematically summarizing the clinical spectrum, radiologic features, pathological subtypes, and surgical outcomes in adults remain scarce. In this study, we retrospectively reviewed 47 adult patients with pathologically confirmed CPAM who underwent surgical resection at our hospital, aiming to provide updated evidence on their demographic characteristics, imaging findings, operative details, pathological features, and follow-up outcomes. \u003cb\u003eFurthermore, patients were stratified into young/adult and middle-to-older age groups, and by the presence or absence of preoperative respiratory infection, to explore subgroup differences and evaluate whether these factors influence clinical presentation, pathological features, and surgical prognosis.\u003c/b\u003e\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy population\u003c/h2\u003e\u003cp\u003eWe retrospectively collected clinical data from adult patients who underwent surgical resection and were pathologically diagnosed with congenital pulmonary airway malformation (CPAM) at the Department of Thoracic Surgery, China-Japan Friendship Hospital, between February 2012 and February 2025. The diagnosis of CPAM was independently confirmed by two experienced pathologists based on hematoxylin\u0026ndash;eosin staining results. Inclusion criteria were as follows: (I) age\u0026thinsp;\u0026ge;\u0026thinsp;18 years at diagnosis; (II) pathologically confirmed CPAM following surgical resection; and (III) complete clinical, imaging, operative, and pathological records. Exclusion criteria included: (I) age\u0026thinsp;\u0026lt;\u0026thinsp;18 years; (II) histology inconsistent with CPAM; and (III) incomplete clinical or follow-up data. This study was conducted in accordance with the Declaration of Helsinki (as revised in 2013), and ethical approval was obtained from the Clinical Research Ethics Committee of the hospital. The requirement for individual informed consent was waived due to the retrospective nature of the study.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eClinical data for all patients were retrospectively collected from the institutional electronic medical record system and surgical database. Variables included: (I) demographic characteristics (sex, age, and body mass index [BMI]); (II) clinical presentation (disease onset time, primary symptoms such as dry cough, productive cough, and fever, preoperative respiratory tract infection status, family history, and smoking history); (III) radiological and pathological features (lesion location, size, morphology, and coexisting lesions such as sequestration, infection, or neoplasia); (IV) laboratory tests (white blood cell count, neutrophil count, neutrophil-to-WBC ratio, forced expiratory volume in 1 second [FEV₁], and diffusing capacity for carbon monoxide [DLCO]); (V) preoperative assessment (American Society of Anesthesiologists [ASA] physical status classification); (VI) surgical information (surgical procedure, operative duration, conversion to thoracotomy, estimated intraoperative blood loss, and other relevant intraoperative details); (VII) postoperative course (length of hospital stay, duration of chest tube drainage, postoperative fever, reoperation, and readmission during follow-up); and (VIII) long-term physical activity tolerance, which was evaluated through telephone follow-up.\u003c/p\u003e\n\u003ch3\u003eSurgical procedures\u003c/h3\u003e\n\u003cp\u003eAll surgeries were performed by thoracic surgeons using video-assisted thoracoscopic surgery (VATS). Conversion to open thoracotomy was determined by intraoperative findings. Resected specimens were examined both macroscopically and microscopically, with representative sections obtained from the capsule wall, solid areas, and any suspicious lesions. A chest drainage tube was placed in each patient postoperatively. The tube was removed when the daily drainage volume was less than 200 mL and no significant air leak was observed, and a chest X-ray was performed to confirm adequate lung expansion.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eStatistical analyses were performed using R software (version 4.4.3). Continuous variables are presented as medians with interquartile ranges, while categorical variables are expressed as frequencies and percentages. A two-sided p-value less than 0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 47 patients with pathologically confirmed CPAM were included in this study. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes baseline characteristics. Among them, 20 cases (42.6%) were males and 27 cases (57.4%) were females; 17 patients (36.2%) had preoperative respiratory tract infection, and 30 (63.8%) did not. Nineteen patients (40.4%) underwent sublobectomy and 28 patients (59.6%) underwent lobectomy; the lesions were most commonly located in the left lower lobe (31.9%) and right lower lobe (36.2%). In addition, 27 patients (57.4%) had different degrees of pleural adhesions, 1 patient switched from thoracoscopic surgery to thoracotomy during surgery, 7 patients (14.9%) had fever after surgery, and 1 patient was readmitted to the hospital for treatment. At the last follow-up, 40 patients (85.1%) reported no significant abnormalities in physical strength and activity tolerance, and 7 patients (14.9%) showed a decrease in physical strength and activity tolerance. The final postoperative pathology showed that 18 cases of CPAM were mixed with other diseases (6 cases of pulmonary bullae, 6 cases of pulmonary fungal disease, 3 cases of pulmonary abscess, 1 case of pulmonary sequestration, 1 case of mucinous adenocarcinoma, and 1 case of thymic cyst). No patients died during or after surgery.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eClinical characteristics of the patients.\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eValue (n\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27 (57.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20 (42.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (year)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e48.00 [33.00, 58.00]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23.38 [22.04, 25.92]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCT size (cm)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5.70 [4.00, 8.25]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePathological size (cm)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4.00 [2.50, 6.50]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLesion morphology\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eunilocular\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24 (51.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emultilocular\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23 (48.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLocation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLUL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5 (10.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLLL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15 (31.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRUL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5 (10.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRML\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5 (10.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRLL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17 (36.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiabetes Mellitus\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (8.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAsthma\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (2.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHypertension\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7 (14.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePreoperative respiratory infection\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17 (36.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePostoperative hospital stay (day)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5.00 [4.00, 6.00]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSymptom duration (month)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5.00 [1.00, 24.00]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDry cough\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22 (46.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFever\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9 (19.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProductive cough\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17 (36.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFamily history\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (2.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmoking\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9 (19.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCardiovascular comorbidity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (8.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWhite blood cell count (\u0026times;10⁹/L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5.97 [4.71, 7.54]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNeutrophil count (\u0026times;10⁹/L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.40 [2.45, 4.28]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNeutrophil-to-lymphocyte ratio\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.57 [0.50, 0.61]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFEV1 (% predicted)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e92.10 [82.70, 105.25]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDLCO (% predicted)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e80.70 [70.40, 90.00]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eASA\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003egrade II\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40 (88.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003egrade III\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5 (11.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOperative time (h)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.67 [1.38, 2.50]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePleural adhesions\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27 (57.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePostoperative fever\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7 (14.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReoperation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReadmission\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (2.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDuration of tube placement(day)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.00 [3.00, 5.00]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIntraoperative bleeding(ml)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20.00 [15.00, 50.00]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTransfusion (ml)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eConversion to open\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (2.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSurgical Procedures\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003esublobar resection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19 (40.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003elobectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28 (59.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePostoperative pathology\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCPAM\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29 (61.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCPAM\u0026thinsp;+\u0026thinsp;PS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (2.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCPAM\u0026thinsp;+\u0026thinsp;LA\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3 (6.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCPAM\u0026thinsp;+\u0026thinsp;PFD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6 (12.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCPAM\u0026thinsp;+\u0026thinsp;LC\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (2.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCPAM\u0026thinsp;+\u0026thinsp;PB\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6 (12.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCPAM\u0026thinsp;+\u0026thinsp;TC\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (2.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLong-term exercise tolerance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003epreserved\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40 (85.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ereduced\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7 (14.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]: \u003cb\u003eContinuous data are expressed as median (interquartile range) and categorical data are expressed as numbers (percentages).BMI: body mass index; CT: computed tomography; RUL: right upper lobe; RML: right middle lobe; RLL: right lower lobe; LUL: left upper lobe; LLL: left lower lobe; FEV1: forced expiratory volume in 1 second; DLCO: diffusing capacity for carbon monoxide; ASA: American Society of Anesthesiologists physical status classification; PS: pulmonary sequestration; LA: lung abscess; PFD: pulmonary fungal disease; LC: lung cancer; PB: pulmonary bullae; TC: thymic cyst; CPAM: congenital pulmonary airway malformation.\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eBased on the natural course of CPAM and the risk of age-related complications, we stratified all patients using 45 years of age as the cutoff point, with 21 patients assigned to the younger group and 26 patients assigned to the older group. A comparison between the two groups revealed statistically significant differences in the following variables (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e): the incidence of preoperative respiratory tract infections was higher in younger patients (57.1% vs. 19.2%, p\u0026thinsp;=\u0026thinsp;0.017). Additionally, the maximum lesion diameter measured by preoperative imaging (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and pathological examination (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) was significantly larger in the younger group than in the older group. Pulmonary function test results showed that DLCO values were higher in older patients than in younger patients (p\u0026thinsp;=\u0026thinsp;0.008). Regarding surgical procedures, lobectomy was more commonly performed in the younger group, while segmentectomy was more commonly performed in the older group (p\u0026thinsp;=\u0026thinsp;0.003).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eComparison of Clinical Characteristics Between Younger and Older Patient Groups.\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eyounger group (\u0026lt;\u0026thinsp;45 years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eolder group (\u0026ge;\u0026thinsp;45 years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.394\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (66.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22.48 [20.96, 24.15]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.95 [22.80, 26.16]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.054\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCT size (cm)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.00 [6.15, 10.60]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.40 [2.80, 5.92]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePathological size (cm)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.40 [4.00, 9.40]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.00 [2.20, 4.00]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLesion morphology\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eunilocular\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (42.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (57.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.473\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emultilocular\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (57.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (42.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLocation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.082\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLUL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (19.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLLL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (30.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRUL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (4.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (15.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRML\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (19.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (3.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRLL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (42.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (30.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiabetes Mellitus\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (4.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (11.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.763\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAsthma\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (4.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.914\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHypertension\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (4.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (23.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.180\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePreoperative respiratory infection\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (57.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (19.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.017\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePostoperative hospital stay (day)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.00 [4.00, 6.00]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.00 [4.00, 6.00]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.931\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSymptom duration (month)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.00 [2.00, 12.00]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.50 [1.00, 24.00]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.755\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDry cough\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (57.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (38.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.326\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFever\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (7.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.065\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProductive cough\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (42.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (30.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.581\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFamily history\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (3.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmoking\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (14.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (23.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.698\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCardiovascular comorbidity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (15.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.176\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWhite blood cell count (\u0026times;10⁹/L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.97 [4.71, 6.96]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.99 [4.76, 7.80]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.716\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNeutrophil count (\u0026times;10⁹/L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.24 [2.38, 3.69]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.41 [2.50, 4.80]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.320\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNeutrophil-to-lymphocyte ratio\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.54 [0.48, 0.59]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.58 [0.51, 0.63]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.083\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFEV1 (% predicted)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e91.10 [83.00, 96.40]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e97.40 [81.45, 112.32]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.171\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDLCO (% predicted)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73.20 [69.30, 80.70]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86.60 [74.88, 95.17]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eASA\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.557\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003egrade II\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (94.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (84.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003egrade III\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (5.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (15.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOperative time (h)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.92 [1.50, 2.50]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.59 [1.25, 2.56]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.346\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePleural adhesions\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (57.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (57.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePostoperative fever\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (19.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (11.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.759\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReoperation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReadmission\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (4.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.914\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDuration of tube placement(day)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.00 [3.00, 4.00]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.00 [2.00, 5.00]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.584\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIntraoperative bleeding(ml)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20.00 [20.00, 50.00]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.00 [12.50, 87.50]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.810\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTransfusion (ml)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.00 [0.00, 0.00]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.00 [0.00, 0.00]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.369\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eConversion to open\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (4.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.914\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSurgical Procedures\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003esublobar resection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (14.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (61.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003elobectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (85.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (38.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePostoperative pathology\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.782\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ewith coexisting lesions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (42.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (34.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ewithout coexisting lesions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (57.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (65.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLong-term exercise tolerance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.605\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epreserved\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (90.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21 (80.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ereduced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (9.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (19.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]: \u003cb\u003eContinuous data are expressed as median (interquartile range) and categorical data are expressed as numbers (percentages). BMI: body mass index; CT: computed tomography; RUL: right upper lobe; RML: right middle lobe; RLL: right lower lobe; LUL: left upper lobe; LLL: left lower lobe; FEV1: forced expiratory volume in 1 second; DLCO: diffusing capacity for carbon monoxide; ASA: American Society of Anesthesiologists physical status classification.\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eWe also categorized patients based on their preoperative respiratory tract infection status into an infection group (n\u0026thinsp;=\u0026thinsp;17) and a non-infection group (n\u0026thinsp;=\u0026thinsp;30) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Patients with preoperative infections were more likely to exhibit respiratory symptoms such as dry cough (p\u0026thinsp;=\u0026thinsp;0.006) and fever (p\u0026thinsp;=\u0026thinsp;0.012). Additionally, the DLCO values in the infection group were significantly lower than those in the non-infection group (p\u0026thinsp;=\u0026thinsp;0.040). In terms of surgical procedures, patients without infection were more likely to undergo sublobar resection, while those with infection were more likely to undergo lobectomy (p\u0026thinsp;=\u0026thinsp;0.037). The infection group also had significantly longer surgical times (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the post-operative chest tube drainage duration was significantly longer in the infection group compared to the non-infection group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.033).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eComparison of Clinical Characteristics Between Patients With and Without Preoperative Respiratory Tract Infection\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003enon-infection group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003einfection group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.870\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18 (60.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9 (52.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8 (47.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23.52 [22.24, 25.84]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23.31 [21.51, 25.71]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.479\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCT size (cm)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5.20 [3.47, 8.15]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.15 [4.80, 8.30]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.245\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePathological size (cm)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.90 [2.35, 6.47]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.00 [2.50, 8.50]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.527\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLesion morphology\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.913\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eunilocular\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16 (53.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8 (47.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emultilocular\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14 (46.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9 (52.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLocation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.363\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLUL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5 (16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLLL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5 (29.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRUL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2 (6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3 (17.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRML\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3 (10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRLL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7 (41.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiabetes Mellitus\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3 (10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAsthma\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (3.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHypertension\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6 (20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.379\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (year)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52.50 [37.50, 59.00]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36.00 [31.00, 45.00]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.111\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePostoperative hospital stay (day)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4.00 [3.25, 5.75]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.00 [4.00, 7.00]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.071\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSymptom duration (month)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.00 [1.00, 21.00]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.00 [3.00, 24.00]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.168\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDry cough\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9 (30.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13 (76.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFever\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2 (6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7 (41.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProductive cough\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8 (26.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9 (52.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.137\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFamily history\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.771\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmoking\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (13.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5 (29.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.337\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCardiovascular comorbidity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3 (10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWhite blood cell count (\u0026times;10⁹/L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5.71 [4.49, 7.48]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.38 [5.53, 7.62]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.358\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNeutrophil count (\u0026times;10⁹/L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.23 [2.39, 3.99]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.69 [2.99, 4.39]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.388\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNeutrophil-to-lymphocyte ratio\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.58 [0.50, 0.61]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.55 [0.53, 0.63]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.842\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFEV1 (% predicted)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e92.50 [81.45, 105.27]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e88.30 [83.00, 99.90]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.587\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDLCO (% predicted)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e84.70 [74.88, 93.60]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e73.20 [68.00, 89.10]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.040\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eASA\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003egrade II\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27 (90.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13 (86.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003egrade III\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3 (10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (13.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOperative time (h)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.50 [1.21, 1.79]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.58 [2.09, 3.25]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePleural adhesions\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12 (70.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.287\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePostoperative fever\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3 (10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4 (23.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.409\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReoperation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReadmission\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.771\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDuration of tube placement(day)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.00 [2.00, 4.00]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.00 [3.00, 5.00]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.033\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIntraoperative bleeding(ml)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20.00 [10.00, 45.00]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50.00 [20.00, 100.00]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.107\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTransfusion (ml)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.00 [0.00, 0.00]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.00 [0.00, 0.00]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.452\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eConversion to open\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (3.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSurgical Procedures\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.037\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003esublobar resection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16 (53.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3 (17.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003elobectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14 (46.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14 (82.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePostoperative pathology\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ewith coexisting lesions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11 (36.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7 (41.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ewithout coexisting lesions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19 (63.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10 (58.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLong-term exercise tolerance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epreserved\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e26 (86.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14 (82.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ereduced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (13.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3 (17.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]: \u003cb\u003eContinuous data are expressed as median (interquartile range) and categorical data are expressed as numbers (percentages). BMI: body mass index; CT: computed tomography; RUL: right upper lobe; RML: right middle lobe; RLL: right lower lobe; LUL: left upper lobe; LLL: left lower lobe; FEV1: forced expiratory volume in 1 second; DLCO: diffusing capacity for carbon monoxide; ASA: American Society of Anesthesiologists physical status classification.\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eCPAM is a rare congenital malformation of the lung, most commonly detected by prenatal ultrasound, with only a minority of cases identified in adulthood[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Patients with CPAM may present with respiratory symptoms such as cough, recurrent infections, or, in severe cases, respiratory failure[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Surgical resection remains the standard treatment for symptomatic CPAM, and prophylactic resection is also frequently recommended for asymptomatic patients to reduce the risks of recurrent infection and malignant transformation[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn this retrospective study of 47 adult patients with pathologically confirmed CPAM, we found that age and preoperative infection status significantly influenced clinical presentation, surgical approach, and perioperative outcomes. Younger patients were more likely to present with preoperative respiratory infections and larger lesions, supporting the rationale for earlier surgical intervention. In contrast, older patients, who often remain asymptomatic and undiagnosed for extended periods, tended to undergo surgery at a more advanced stage. Patients with preoperative infections demonstrated more severe respiratory symptoms, reduced pulmonary function, longer operative times, prolonged chest tube drainage, and a higher likelihood of requiring lobectomy. Moreover, more than one-third of cases were complicated by other pulmonary conditions, including one case of mucinous adenocarcinoma, underscoring the heterogeneity and malignant potential of adult CPAM. Notably, long-term follow-up demonstrated that most patients achieved favorable functional recovery, with preservation of physical strength and exercise tolerance.\u003c/p\u003e\u003cp\u003eOur findings are consistent with previous large-scale studies of adult CPAM. Zeng et al. analyzed adult patients and reported that recurrent respiratory infections and pneumonia were common, but that the disease was also frequently detected incidentally during imaging examinations for other conditions, highlighting the diverse clinical presentation of CPAM[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Case reports further suggest that early surgical resection in adults is both safe and effective, with curative outcomes achieved in many instances[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Similarly, in our study, perioperative outcomes were favorable, with no surgical deaths and only one patient requiring conversion to thoracotomy. Importantly, patients with preoperative infections experienced greater surgical difficulty and delayed recovery, which aligns with previous reports suggesting that infection and inflammation contribute to thickened adhesions, tissue edema, and increased surgical complexity[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAnother important finding of this study was the high prevalence of concomitant pulmonary lesions. Notably, 6 patients developed fungal infections within CPAM lesions. The structural abnormalities of CPAM, such as impaired drainage and mucus retention, provide a favorable environment for opportunistic fungi. Such infections may exacerbate respiratory symptoms, lead to persistent inflammation, and cause dense pleural adhesions, thereby increasing operative difficulty. Surgical resection in these cases not only addresses the congenital malformation but also eradicates the fungal focus, which is often difficult to control with antifungal therapy alone[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In addition to infection, the identification of mucinous adenocarcinoma within a CPAM lesion in our cohort underscores the malignant potential of this anomaly. Previous studies have reported somatic KRAS mutations in CPAM-associated adenocarcinomas, and DICER1 mutations have been linked to CPAM type 4 and pleuropulmonary blastoma[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Taken together, these findings emphasize the necessity of complete surgical excision, meticulous histopathological evaluation, and long-term surveillance, even in asymptomatic adult patients.\u003c/p\u003e\u003cp\u003eSurgical decision-making in adult CPAM requires comprehensive consideration of multiple factors. Sublobar resection is increasingly favored for its parenchyma-sparing advantages, particularly in older patients where preservation of lung function is a priority. In contrast, for younger patients with larger lesions or those with preoperative infections, complete resection through lobectomy may be more appropriate to ensure surgical safety and oncological completeness. Our study reflects this clinical reality: sublobar resections were more commonly performed in older patients, whereas lobectomies were more frequent among younger and infected patients. These observations underscore the necessity of developing individualized surgical strategies that incorporate patient age, lung function, infection status, and lesion characteristics, rather than applying a uniform surgical approach.\u003c/p\u003e\u003cp\u003eLong-term follow-up in our cohort further supports the safety and benefits of surgical resection. At the final follow-up, 85.1% of patients reported no decline in physical strength or exercise tolerance, and no perioperative or follow-up deaths occurred, with only one patient requiring readmission. These favorable outcomes indicate that surgical resection not only alleviates symptoms and prevents recurrent infections but also preserves long-term quality of life[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The inclusion of functional follow-up data provides additional evidence confirming both the safety and the sustained benefits of surgery for adult CPAM.\u003c/p\u003e\u003cp\u003eThis study has several limitations that should be acknowledged. First, it was a single-center retrospective analysis, and selection bias cannot be excluded. Only patients undergoing surgical resection were included, which may underestimate the prevalence of asymptomatic or mildly symptomatic adults with CPAM and does not reflect the full natural history of the disease. Second, although the sample size of 47 patients is moderate compared with prior series, it remains relatively small and insufficient for robust subgroup analyses, limiting the generalizability of our findings. Third, perioperative and follow-up data were primarily derived from medical records and telephone interviews. Long-term outcomes were assessed mainly through subjective measures of functional recovery, such as physical strength and exercise tolerance, without systematic imaging or pulmonary function testing, which may underestimate silent recurrences or late complications. Fourth, although one case of mucinous adenocarcinoma was observed, molecular and genetic analyses were not performed, limiting further insights into the oncogenic mechanisms of CPAM. Finally, the absence of a non-surgical control group prevents direct comparisons between surgical and conservative management and precludes assessment of the optimal timing of intervention. These limitations highlight the need for larger, multicenter, prospective studies that incorporate functional, radiological, and molecular data to refine surgical indications and optimize long-term management strategies.\u003c/p\u003e\u003cp\u003eIn summary, this study highlights the heterogeneity of adult CPAM and emphasizes the influence of age and preoperative infection status on clinical presentation, surgical decision-making, and perioperative outcomes. For younger patients with larger or infected lesions, lobectomy should be prioritized to ensure surgical completeness and safety, whereas in older patients, preservation of lung function should be a key consideration. Importantly, our follow-up data demonstrate favorable long-term outcomes, supporting the role of surgical resection in the management of adult CPAM. Collectively, these findings provide new evidence to guide personalized surgical strategies and long-term management of this rare disease.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study indicates that adult CPAM requires personalized surgical management. Surgical intervention remains the optimal treatment approach, ensuring symptom relief and long-term functional preservation. Additionally, the presence of concomitant pulmonary diseases should be carefully considered in surgical planning. Future studies should further clarify surgical indications.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eAuthor information\u003c/h2\u003e\u003cp\u003eAuthors and Affiliations\u003c/p\u003e\u003cp\u003eDepartment of General Thoracic Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing, 100029, China.\u003c/p\u003e\u003cp\u003eChina-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences \u0026amp; Peking Union Medical College, Beijing, China.\u003c/p\u003e\u003cp\u003eDefeng Luo, Weixun Zhang, Xiangyue Liao, Chaoyang Liang, Weijie Zhu\u003c/p\u003e\u003cp\u003eContributions\u003c/p\u003e\u003cp\u003eW.Z. conceived and designed the study. D.L. was involved in data acquisition and wrote the manuscript. X.L., W.Z. and C.L. analyzed the data. W.Z. revised the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003cp\u003eCorresponding author: Correspondence to \u003cb\u003eWeijie Zhu\u003c/b\u003e.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003e\u003cb\u003eEthics declarations\u003c/b\u003e\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003e All procedures adhered to the principles outlined in the Declaration of Helsinki. The study protocol and related documents were approved by the Clinical Research Ethics Committee of China-Japan Friendship Hospital and the need for informed consent was waived.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot Applicable\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding Statement:\u003c/h2\u003e\u003cp\u003eThis work was supported by the National High Level Hospital Clinical Research Funding, and the Special Fund (2060204) of the State Key Laboratory of Respiratory Health and Multimorbidity (2024-QZZZ-05), the Elite Medical Professionals Project of China-Japan Friendship Hospital (ZRJY2023-QM34).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eW.Z. conceived and designed the study. D.L. was involved in data acquisition and wrote the manuscript. X.L., W.Z. and C.L. analyzed the data. W.Z. revised the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZeng Z, Liu C, Liu C, Pu Q, Mei J, Liao H\u003cem\u003e et al.\u003c/em\u003e \u003cem\u003eClinical characteristics and surgical treatment of congenital cystic adenomatoid malformation in adults: the largest cohort of 46 patients\u003c/em\u003e. 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Histopathology 2002;\u003cstrong\u003e41\u003c/strong\u003e:424-30.\u003c/li\u003e\n\u003cli\u003eKwon YS, Koh WJ, Han J, Choi YS, Kim K, Kim J\u003cem\u003e et al.\u003c/em\u003e \u003cem\u003eClinical characteristics and feasibility of thoracoscopic approach for congenital cystic adenomatoid malformation in adults\u003c/em\u003e. Eur J Cardiothorac Surg 2007;\u003cstrong\u003e31\u003c/strong\u003e:797-801.\u003c/li\u003e\n\u003cli\u003ePederiva F, Rothenberg SS, Hall N, Ijsselstijn H, Wong KKY, von der Th\u0026uuml;sen J\u003cem\u003e et al.\u003c/em\u003e \u003cem\u003eCongenital lung malformations\u003c/em\u003e. Nat Rev Dis Primers 2023;\u003cstrong\u003e9\u003c/strong\u003e:60.\u003c/li\u003e\n\u003cli\u003eCeylan KC, Batihan G, \u0026Uuml;\u0026ccedil;vet A, G\u0026uuml;rsoy S. \u003cem\u003eSurgery in congenital lung malformations: the evolution from thoracotomy to VATS, 10-year experience in a single center\u003c/em\u003e. J Cardiothorac Surg 2021;\u003cstrong\u003e16\u003c/strong\u003e:131.\u003c/li\u003e\n\u003cli\u003eHerrero Y, Pinilla I, Torres I, Nistal M, Pardo M, G\u0026oacute;mez N. \u003cem\u003eCystic adenomatoid malformation of the lung presenting in adulthood\u003c/em\u003e. Ann Thorac Surg 2005;\u003cstrong\u003e79\u003c/strong\u003e:326-9.\u003c/li\u003e\n\u003cli\u003eOh BJ, Lee JS, Kim JS, Lim CM, Koh Y. \u003cem\u003eCongenital cystic adenomatoid malformation of the lung in adults: clinical and CT evaluation of seven patients\u003c/em\u003e. Respirology 2006;\u003cstrong\u003e11\u003c/strong\u003e:496-501.\u003c/li\u003e\n\u003cli\u003eCasagrande A, Pederiva F. \u003cem\u003eAssociation between Congenital Lung Malformations and Lung Tumors in Children and Adults: A Systematic Review\u003c/em\u003e. J Thorac Oncol 2016;\u003cstrong\u003e11\u003c/strong\u003e:1837-45.\u003c/li\u003e\n\u003cli\u003eLuj\u0026aacute;n M, Bosque M, Mirapeix RM, Marco MT, Asensio O, Domingo C. \u003cem\u003eLate-onset congenital cystic adenomatoid malformation of the lung. Embryology, clinical symptomatology, diagnostic procedures, therapeutic approach and clinical follow-up\u003c/em\u003e. Respiration 2002;\u003cstrong\u003e69\u003c/strong\u003e:148-54.\u003c/li\u003e\n\u003cli\u003eAljarad B, Alkhayer I, Alturk A, Qatleesh S, Bara A. \u003cem\u003eA rare case of congenital pulmonary airway malformation in a 14-year-old male presenting with spontaneous pneumothorax\u003c/em\u003e. Ann Med Surg (Lond) 2021;\u003cstrong\u003e68\u003c/strong\u003e:102692.\u003c/li\u003e\n\u003cli\u003eWong KKY, Flake AW, Tibboel D, Rottier RJ, Tam PKH. \u003cem\u003eCongenital pulmonary airway malformation: advances and controversies\u003c/em\u003e. Lancet Child Adolesc Health 2018;\u003cstrong\u003e2\u003c/strong\u003e:290-97.\u003c/li\u003e\n\u003cli\u003eMarkou GA, Dafereras G, Poncelet C. \u003cem\u003eCongenital Cystic Adenomatoid Malformation Diagnosed During First-Trimester Ultrasound Scan\u003c/em\u003e. Am J Case Rep 2018;\u003cstrong\u003e19\u003c/strong\u003e:1-4.\u003c/li\u003e\n\u003cli\u003evan Horik C, Zuidweg MJP, Boerema-de Munck A, Buscop-van Kempen M, Brosens E, Vahrmeijer AL\u003cem\u003e et al.\u003c/em\u003e \u003cem\u003eSelection of potential targets for stratifying congenital pulmonary airway malformation patients with molecular imaging: is MUC1 the one?\u003c/em\u003e Eur Respir Rev 2023;\u003cstrong\u003e32\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eMorini F, Zani A, Conforti A, van Heurn E, Eaton S, Puri P\u003cem\u003e et al.\u003c/em\u003e \u003cem\u003eCurrent Management of Congenital Pulmonary Airway Malformations: A \u0026quot;European Pediatric Surgeons\u0026apos; Association\u0026quot; Survey\u003c/em\u003e. Eur J Pediatr Surg 2018;\u003cstrong\u003e28\u003c/strong\u003e:1-5.\u003c/li\u003e\n\u003cli\u003eLo AY, Jones S. \u003cem\u003eLack of consensus among Canadian pediatric surgeons regarding the management of congenital cystic adenomatoid malformation of the lung\u003c/em\u003e. J Pediatr Surg 2008;\u003cstrong\u003e43\u003c/strong\u003e:797-9.\u003c/li\u003e\n\u003cli\u003eValentin M, Sharma R, Trabanco J, Ashby T. \u003cem\u003eCongenital Pulmonary Airway Malformation in an Adult Male Presenting With Hemoptysis\u003c/em\u003e. Cureus 2022;\u003cstrong\u003e14\u003c/strong\u003e:e20862.\u003c/li\u003e\n\u003cli\u003eJaggi TK, Agarwal R, Tiew PY, Shah A, Lydon EC, Hage CA\u003cem\u003e et al.\u003c/em\u003e \u003cem\u003eFungal lung disease\u003c/em\u003e. Eur Respir J 2024;\u003cstrong\u003e64\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eBrcic L, Fakler F, Eidenhammer S, Thueringer A, Kashofer K, Kulka J\u003cem\u003e et al.\u003c/em\u003e \u003cem\u003ePleuropulmonary blastoma type I might arise in congenital pulmonary airway malformation type 4 by acquiring a Dicer 1 mutation\u003c/em\u003e. Virchows Arch 2020;\u003cstrong\u003e477\u003c/strong\u003e:375-82.\u003c/li\u003e\n\u003cli\u003eShanmugam G. \u003cem\u003eAdult congenital lung disease\u003c/em\u003e. Eur J Cardiothorac Surg 2005;\u003cstrong\u003e28\u003c/strong\u003e:483-9.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"congenital pulmonary airway malformation, congenital lung disease, adult, surgery, outcomes","lastPublishedDoi":"10.21203/rs.3.rs-7481323/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7481323/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eCongenital pulmonary airway malformation (CPAM) is a rare developmental anomaly of the lung that is predominantly diagnosed in infancy, whereas adult cases remain uncommon. Comprehensive evidence regarding clinical characteristics, surgical management, and long-term outcomes in adults is limited.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003e We retrospectively reviewed 47 adult patients with pathologically confirmed CPAM who underwent surgical resection at a single tertiary center from 2012 to 2025. Clinical data, radiologic features, operative details, pathological findings, and follow-up outcomes were analyzed. Subgroup analyses were performed according to age and preoperative respiratory infection status.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe cohort included 20 males and 27 females with a median age of 44 years. Common lesion sites were the left lower lobe (31.9%) and right lower lobe (36.2%). Nineteen patients (40.4%) underwent sublobectomy and 28 (59.6%) lobectomy. Preoperative infection occurred in 17 patients (36.2%), who exhibited more respiratory symptoms, lower pulmonary function, longer operative times, and prolonged chest drainage compared with non-infected patients (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Younger patients presented more frequently with infections and larger lesions, and lobectomy was more commonly performed in this group. Postoperative complications were infrequent, with no perioperative mortality. During follow-up, 85.1% of patients reported preserved physical strength and activity tolerance. Pathology revealed concomitant pulmonary lesions in 18 cases (38.3%), including one mucinous adenocarcinoma.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eAdult CPAM exhibits heterogeneous clinical manifestations and is frequently complicated by infection or other pulmonary diseases. Surgical resection is safe and effective, providing favorable long-term functional recovery. Personalized surgical planning is essential, and more studies are required to refine management strategies.\u003c/p\u003e","manuscriptTitle":"Clinical Features and Outcomes of Adult Congenital Pulmonary Airway Malformation: A 47-Case Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-20 07:27:46","doi":"10.21203/rs.3.rs-7481323/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-10-28T13:43:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-20T10:02:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-13T16:45:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"309002521049979787183944727232975039433","date":"2025-10-09T21:43:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"326563539896657549451286074519275226304","date":"2025-10-09T13:27:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"114511313834298980575844669982900724000","date":"2025-10-07T13:57:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-07T13:16:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-02T17:43:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-30T13:30:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-30T13:29:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pulmonary Medicine","date":"2025-08-28T14:32:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0d7298d3-2d24-4b17-baaa-3476dd6bc049","owner":[],"postedDate":"October 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-20T07:27:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-20 07:27:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7481323","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7481323","identity":"rs-7481323","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}