Morbidity after thoracoscopic resection of congenital pulmonary airway malformations (CPAM): single center experience over a decade
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In brief
In brief
This 10-year retrospective study of 73 children undergoing VATS resection for CPAM found an 11% major complication rate and no impact on respiratory symptoms in previously symptomatic patients. The findings suggest surgical risks may outweigh benefits in asymptomatic children with CPAM.
Written by the GCMD Library team from the article.
Abstract
Purpose
Video-assisted thoracoscopic (VATS) resection of CPAM in children is an established, albeit controversial strategy for its management. We report a 10-year single center experience.
Methods
All children underwent VATS (2008–2017) and their current status was reviewed. Patients were grouped: ‘symptomatic-P’ (if parents reported recurrent lower respiratory tract infections etc.) or ‘symptomatic-S’ (neonates presenting with respiratory distress/difficulty) or ‘asymptomatic’.
Results
73 children, aged 10 m (4d–14yrs) underwent VATS; a neonate as an emergency (‘symptomatic-S’) and all others electively. The lesion was unilateral in all but one case. Histologically none were malignant. Of the elective 72 cases, 7 (10%) required conversion to open thoracotomy. Twenty (27.7%) were ‘symptomatic-P’ and the duration of surgery when compared to ‘asymptomatic’ children was longer 269 (range 129–689) versus 178 (range 69–575) minutes (P = 0.01). Post operatively, 8 children (11%) had a grade III/IV (Clavien–Dindo) complication; persistent air leak/pneumothorax (n = 5), chylothorax (n = 1), pleural effusion (n = 1) and seizure/middle cerebral artery thrombosis (n = 1). There was no mortality. Twenty-four children (33.3%) were reported ‘symptomatic-P’ post-surgery after a median follow up of 2.18 years. The surgical intervention had no impact on ‘symptomatic-P’ status (P = 0.46).
Conclusion
The risks of surgery may outweigh benefit in asymptomatic children.
ClinicalTrials.gov Identifier
NCT04449614.