{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T19:53:29Z","timestamp":1792180409398,"version":"4.4.0"},"reference-count":38,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Endobronchial tumors represent a heterogeneous spectrum of benign and malignant histopathological types. Selecting the optimal surgical strategy remains a multidisciplinary challenge. This study evaluates how the integration of spirometry, DLCO, and CPET can objectively stratify cardiorespiratory risk and guide surgical decision-making regarding resection type, postoperative complications, and perioperative mortality. Methods: A single-center, retrospective study was conducted between 2020 and 2025, evaluating an initial screening cohort of 93 patients with endobronchial masses. Following multidisciplinary tumor board review based on functional and anatomical criteria, 36 patients were excluded from major resection due to extensive disease or prohibitive functional risk, while 57 underwent tailored surgical interventions, including sleeve resections, lobectomies, bilobectomies, and pneumonectomies. Preoperative evaluation included spirometry, DLCO, cardiological assessment, CT, and autofluorescence bronchoscopy (AFB). Results: Spearman correlation analysis demonstrated that advanced age and higher ASA scores significantly correlated with reduced preoperative DLCO (p &lt; 0.0001). The overall postoperative morbidity rate was 36.84% (n = 21) and perioperative mortality was 5.26% (n = 3). Stratified analysis by surgical magnitude demonstrated a significant escalation in overall complication rates from parenchymal-sparing sleeve resections (17.6%, 95% CI: 3.8% to 43.4%) to standard lobectomies (40.7%, 95% CI: 22.4% to 61.2%), bilobectomies (50.0%, 95% CI: 15.7% to 84.3%), and radical pneumonectomies (60.0%, 95% CI: 14.7% to 94.7%; p = 0.042). Severe morbidity (Clavien\u2013Dindo Grade III\u2013IV) was significantly lower in the sleeve resection subgroup (5.8%) compared to pneumonectomies (40.0%, p = 0.015). Fatal outcomes occurred exclusively following major resections and were attributable to ARDS and acute cardiovascular events. Conclusions: A multi-parametric preoperative protocol provides an informative framework for risk stratification in endobronchial tumor surgery, helping to describe baseline reserves and explore post-resection trends. However, the anatomical and hemodynamic magnitude of radical pneumonectomy constitutes an independent risk modifier that cannot be fully captured by preoperative functional testing alone, highlighting the exploratory nature of these single-center retrospective observations rather than a definitive algorithmic validation.<\/jats:p>","DOI":"10.3390\/jcm15145605","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T05:32:17Z","timestamp":1784266337000},"page":"5605","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Functional Stratification and Postoperative Outcomes in Endobronchial Tumor Surgery: A Dedicated Center Experience"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-2334-9352","authenticated-orcid":false,"given":"Radu","family":"Matache","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, \u201cMarius Nasta\u201d National Institute of Pneumology, 050150 Bucharest, Romania"},{"name":"Thoracic Surgery I, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3856-7917","authenticated-orcid":false,"given":"Silviu Gabriel","family":"Vl\u0103sceanu","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, \u201cMarius Nasta\u201d National Institute of Pneumology, 050150 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9240-922X","authenticated-orcid":false,"given":"Beatrice","family":"Mahler","sequence":"additional","affiliation":[{"name":"Department of Pneumology, \u201cMarius Nasta\u201d National Institute of Pneumology, 050150 Bucharest, Romania"},{"name":"Pneumoftisiology II Discipline, Faculty of Medicine, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru","family":"Stoichi\u021b\u0103","sequence":"additional","affiliation":[{"name":"Department of Pneumology, \u201cMarius Nasta\u201d National Institute of Pneumology, 050150 Bucharest, Romania"},{"name":"Pneumoftisiology II Discipline, Faculty of Medicine, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6256-6312","authenticated-orcid":false,"given":"Camelia Alexandra","family":"Paruschi","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, \u201cMarius Nasta\u201d National Institute of Pneumology, 050150 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina Elena","family":"Tucana","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, \u201cMarius Nasta\u201d National Institute of Pneumology, 050150 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Ni\u021b\u0103","sequence":"additional","affiliation":[{"name":"Department of Oncology, Medicover Hospital, 020331 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrei Cristian","family":"Bobocea","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, \u201cMarius Nasta\u201d National Institute of Pneumology, 050150 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6419-7805","authenticated-orcid":false,"given":"Cornel Florentin","family":"Savu","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, \u201cMarius Nasta\u201d National Institute of Pneumology, 050150 Bucharest, Romania"},{"name":"Thoracic Surgery I, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"ref_1","first-page":"487","article-title":"Lung Cancer: Diagnosis, Treatment Principles, and Screening","volume":"105","author":"Kim","year":"2022","journal-title":"Am. 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