Thoracoscopic surgery for congenital lung malformations: Does previous infection really matter?

Infographic · Feb 2022 · 1 min read

In brief

Retrospective study of 90 pediatric patients demonstrates that prior pulmonary infection in congenital lung malformation cases significantly increases conversion rates (35.7% vs 12.9%), operative time, and postoperative fever. Findings support earlier elective thoracoscopic resection before infectious complications develop to optimize surgical outcomes.

Previous pulmonary infection increases conversion rate from thoracoscopic to open surgery (35.7% vs 12.9%, p=0.02)
Earlier CLM resection before infection results in shorter operative time and reduced postoperative fever (32.1% vs 11.3%, p=0.03)
Patients with prior infection require antibiotics more frequently postoperatively (28.6% vs 6.5%, p=0.007)
Elective thoracoscopic resection before first infection optimizes surgical outcomes without increasing complication rates
Median age at surgery was higher in previously infected patients (20.4 vs 15.1 months, p=0.006)

Written by the GCMD Library team from the infographic.

Split-panel infographic with red accent colors. Left panel shows a simplified figure with congenital lung malformations. Right panel displays lungs with virus icon, leading to two outcome icons: complications (warning symbol) and conversion to open surgery (surgical instruments). Red arrow connects the panels emphasizing the infection-to-complication pathway.

Background/ Purpose

Elective resection of congenital lung malformations (CLMs) is still debatable. The two main risks are malignant transformation and recurrent pulmonary infections. Our study aimed to assess the effect of previous pulmonary infection on the intraoperative and postoperative courses of thoracoscopic surgery for CLMs.

Methods

This is a retrospective study including all thoracoscopic lung resections for CLMs between 2010 and 2019. Ninety patients were included. There was a history of previous pulmonary infection in 28 patients (group A) and no such history in 62 patients (group B).

Results

The median age at operation for group A was 20.4 months (IQR:14.9–41.4) versus 15.1 months (IQR:9.7–20.8) in group B (p = 0.006). There were 10 conversions (35.7%) in group A and 8 (12.9%) in group B (p = 0.02). The operative time was significantly shorter in group B (p<0.002). In group A, 32.1% of patients experienced postoperative fever versus 11.3% of group B (p = 0.03), with higher antibiotics requirement (28.6% versus 6.5% respectively, p = 0.007). However, no significant differences were found in terms of postoperative complications (p = 0.99).

Conclusion

Earlier intervention for CLMs before the development of pulmonary infection carries higher chances for the success of the thoracoscopic approach with shorter operative time and more uneventful postoperative courses.

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