THORACOSCOPIC VERSUS OPEN RESECTION IN CHILDREN WITH ASYMPTOMATIC LUNG MALFORMATIONS

Uh, thank you and uh good morning, IPEC members and guests. Uh, I have no disclosures. Over the last decade, thoracoscopic resection has become a popular operative modality for the management of congenital lung malformations or CLMs. However, whether outcomes are truly better than open recession remains controversial. Therefore, the purpose of this study was to evaluate outcomes of children undergoing elective resection of an asymptomatic CLM within a multi-center research collaborative. This was a Century Alliance IRB approved retrospective study of all elective CLM resections performed in asymptomatic children between 2009 and 2015 across 11 major US children's hospitals. Outcomes data included operative time, hospital length of stay, and complications. There were a total of 311 elective resections during the study period. The table on the right side shows an equivalent right-left distribution, as well as a predominance of lower lobe lesions as expected, and pathologically, the most common pathology was uh congenital pulmonary airway malformation or CPAM in 51%. With regards to operative approach, uh, 42% uh had this uh purely open procedure via thoracotomy, whereas, uh, 48% successfully underwent thoracoscopic resection. Almost 10%, however, I had thoracoscopic converted to open repairs, which translates to a conversion rate of about 17%. The table on the right shows that 59 surgeons actually participated in successfully completed MIS resection. Looking at operative approach by year, uh, these data show that in the, in the white bars there, that the open procedure decreased steadily in number over the time period, whereas the MIS approach steadily increased as shown there in the blue. Presented a different way with the graph on the left showing the relative change in MIS over time. In 2009, there were 17% of us that were doing MIS resections, which increased to 76% by the end of the study. And as you can see in the red, the conversion rate went steadily down and was 3% by 2015. We also queried operative reports to better understand what the reasons for conversion were, and by far and away the most common reason for conversion was a poor visualization of the operative field. This graph looks at elective lung resection by institution on the x axis versus the percent of MIS repairs. I think you can appreciate that there really seems to be no correlation between hospital operative volume and the likelihood of undergoing a thoracoscopic resection. We then looked at baseline demographics as well as other clinical features in children who underwent open versus MIS resection. Uh, there was a slightly increased comorbidities in the open group as well as lobectomy rates, however, they were roughly equal otherwise. And finally we looked at outcomes and somewhat surprisingly, the operative time for the MIS approach was only 8 minutes longer than the open approach, uh, with a length of stay that was slightly decreased at a median length of stay of 2.5 days and a complication rate of about 12%. Uh, critically, we performed multivariate regression analysis. We're able to control such factors such as age, weight, comorbidities, and other, uh, variables, and operative approach was not a significant predictor of outcome, uh, in this analysis. So in summary, uh, this data from a multi-center consortium shows that thoracoscopic resection is now the most common elective approach for the management of CLMs and with fairly good results. We've seen declining rates of conversion over time, uh, thereby suggesting that MIS techniques can be safely adopted even amongst the more mortal surgeons amongst us. Moreover, despite the learning curve that is involved, uh, MIS procedures, uh, resection appears to be equivalent with regards to perioperative outcomes. Finally, I would like to thank all of the NWPSC investigators for making this study possible. Uh, thank you very much for your attention, and I'll be happy to answer any questions.