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Ichino M, Morandi A, Macchini F, Maestri F, Consonni D, Farolfi A, Ophorst M, Leva E. Congenital Lung Malformations: Pulmonary Function Assessment Before and After Surgery. J Pediatr Surg 2023; 58:2081-2087. [PMID: 37586902 DOI: 10.1016/j.jpedsurg.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 07/15/2023] [Accepted: 07/16/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND The management of asymptomatic congenital lung malformations (CLM) is debated, and pulmonary function of patients with CLM is seldom discussed. Short-term respiratory outcome in patients operated for CLM was assessed in order to better define surgical impact. METHODS A retrospective study on patients operated for CLM between 2012 and 2021 was performed. Respiratory function was assessed with tidal breath analysis (TBA) in spontaneous sleep within 2 years of life. Patients with comorbidities affecting pulmonary function were excluded. Three variables were studied: tPTEF/tE (time to peak tidal expiratory flow/total expiratory time), tV (tidal volume), RR (respiratory rate). Results were assessed as z-score (normal ±1.64) and expressed as median (range). Pre- and post-operative results were compared, as well as post-operative results of disease and surgery type subgroups. RESULTS Thirty-nine patients were included. Median pre- and post-operative tPTEF/tE were normal (pre: -0.32 (-2.12; +1.56); post: -0.18 (-1.62; +2.43)). Patients with extralobar sequestration had pre-operative high median RR, which improved after sequestrectomy (pre: +1.99 (-2.49; +7.43); post -0.22 (-3.01; +1.18)). All groups had reduced pre-operative median tV, which restored after surgery (pre: -2.15 (-9.75; +0.91); post: -0.35 (-6.65; +3.14)). Patients undergoing lobectomy and patients with intralobar sequestration showed greater improvement. Median post-operative TBA results were normal for all sub-groups except for reduced tV in patients operated with thoracotomy (-2.27 (-6.12; +5.26)). CONCLUSIONS Patients with clinically asymptomatic CLM can have pathologic pulmonary function tests, which improve after surgery. These results add to the elements in favor of an interventional approach. LEVEL OF EVIDENCE III, Treatment study.
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Affiliation(s)
- Martina Ichino
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy.
| | - Anna Morandi
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Francesco Macchini
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Francesca Maestri
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Andrea Farolfi
- Neonatal Intensive Care Unit (NICU), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Marijke Ophorst
- Neonatal Intensive Care Unit (NICU), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Ernesto Leva
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122, Milan, Italy
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Liu C, Liu J, Yuan M, Cheng K, Luo D, Zeng L, Xu C. Pulmonary function after lobectomy in children: a systematic review and meta-analysis. BMJ Paediatr Open 2023; 7:e001979. [PMID: 37848263 PMCID: PMC10582896 DOI: 10.1136/bmjpo-2023-001979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/26/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND The influence of lobectomy on pulmonary function in children was still controversial. A systematic review and meta-analysis were essential to explore whether pulmonary function was impaired after lobectomy in children. METHODS PubMed, Embase and Web of Science were searched from 1 January 1946 to 1 July 2022. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC and total lung capacity were extracted from the studies as the primary analysis indicators. Subgroup analyses were performed between the congenital lung malformation (CLM) group and other diseases group, early surgery and late surgery group (1 year old as the dividing line). RESULTS A total of 5302 articles were identified through the search strategy; finally, 10 studies met the inclusion criteria. Through the meta-analysis, we found a mild obstructive ventilatory disorder in children who underwent lobectomy. However, a normal pulmonary function could be found in young children with CLM who underwent lobectomy, and the time of operation had no significant influence on their pulmonary function. CONCLUSIONS The overall result of pulmonary function after lobectomy in children was good. Surgeons may not need to be excessively concerned about the possibility of lung surgery affecting pulmonary function in children, particularly in patients with CLM. PROSPERO REGISTRATION NUMBER CRD42022342243.
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Affiliation(s)
- Chenyu Liu
- Department of Pediatric Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Jie Liu
- Department of Pediatric Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Miao Yuan
- Department of Pediatric Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Kaisheng Cheng
- Department of Pediatric Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Dengke Luo
- Department of Pediatric Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Li Zeng
- Department of Pediatric Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Chang Xu
- Department of Pediatric Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
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Willers C, Maager L, Bauman G, Cholewa D, Stranzinger E, Raio L, Casaulta C, Latzin P. School-age structural and functional MRI and lung function in children following lung resection for congenital lung malformation in infancy. Pediatr Radiol 2022; 52:1255-1265. [PMID: 35305121 PMCID: PMC9192451 DOI: 10.1007/s00247-022-05317-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 10/21/2021] [Accepted: 02/03/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND The management of asymptomatic congenital lung malformations is debated. Particularly, there is a lack of information regarding long-term growth and development of the remaining lung in children following lung resection for congenital lung malformations. In addition to conventional pulmonary function tests, we used novel functional magnetic resonance imaging (MRI) methods to measure perfusion and ventilation. OBJECTIVE To assess functionality of the remaining lung expanded into the thoracic cavity after resection of congenital lung malformations. MATERIALS AND METHODS A prospective, cross-sectional pilot study in five children who had surgery for congenital lung malformations during infancy. Participants had structural and functional MRI as well as spirometry, body plethysmography and multiple breath washout at school age. RESULTS Structural MRI showed an expansion of the remaining lung in all cases. Fractional ventilation and relative perfusion of the expanded lung were locally decreased in functional MRI. In all other parts of the lungs, fractional ventilation and relative perfusion were normal in all children. There was an association between overall impairment of perfusion and elevated lung clearance index. The results of spirometry and body plethysmography varied between patients, including normal lung function, restriction and obstruction. CONCLUSION Fractional ventilation and relative perfusion maps from functional MRI specifically locate impairment of the remaining lung after lung resection. These changes are not captured by conventional measures such as structural MRI and standard pulmonary function tests. Therefore, following lung resection for congenital lung malformation, children should be investigated more systematically with functional lung MRI.
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Affiliation(s)
- Corin Willers
- grid.5734.50000 0001 0726 5157Division of Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010 Bern, Switzerland
| | - Lukas Maager
- grid.5734.50000 0001 0726 5157Division of Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010 Bern, Switzerland
| | - Grzegorz Bauman
- grid.410567.1Division of Radiological Physics, Department of Radiology, University of Basel Hospital, Basel, Switzerland ,grid.6612.30000 0004 1937 0642Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Dietmar Cholewa
- grid.5734.50000 0001 0726 5157Department of Pediatric Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Enno Stranzinger
- grid.5734.50000 0001 0726 5157Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luigi Raio
- grid.5734.50000 0001 0726 5157Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carmen Casaulta
- grid.5734.50000 0001 0726 5157Division of Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010 Bern, Switzerland
| | - Philipp Latzin
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland.
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Tocchioni F, Lombardi E, Ghionzoli M, Ciardini E, Noccioli B, Messineo A. Long-term lung function in children following lobectomy for congenital lung malformation. J Pediatr Surg 2017; 52:1891-1897. [PMID: 28951013 DOI: 10.1016/j.jpedsurg.2017.08.059] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 08/28/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND/PURPOSE To date, the optimal management of asymptomatic congenital lung malformations (CLMs) is still debated. There is still scant and controversial information regarding the long-term assessment of pulmonary function (PF) after lobectomy in children. The aim of this study is to evaluate PF in children who underwent lobectomy for CLM in infancy, hypothesizing that patients operated during the first year of life retain a normal lung function. METHODS Children operated between 2005 and 2016 at our institution underwent PF evaluation through spirometry/whole-body plethysmography, forced oscillation technique, and multiple-breath inert gas wash-out. RESULTS Out of 85 patients who underwent lobectomy at a median age of 5months, 50 met the inclusion criteria, and 28 patients were tested. More than 80% of patients had normal FEV1 and FVC. The mean FEV1, FVC, FEF25-75% values were higher in the patients operated before reaching one year of age. CONCLUSIONS The long-term outcome after lobectomy was excellent for most patients, as they retained a normal long-term PF. Therefore, for asymptomatic patients, a surgical approach before one year of age to avoid complications such as malignancy and to ensure an optimal PF catch-up could be beneficial. LEVEL OF EVIDENCE III - Treatment Studies.
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Affiliation(s)
- Francesca Tocchioni
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Enrico Lombardi
- Pediatric Pulmonary Unit, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Marco Ghionzoli
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Enrico Ciardini
- Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy
| | - Bruno Noccioli
- Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy
| | - Antonio Messineo
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy.
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Dunn A, Pearce K, Callister R, Collison A, Morten M, Mandaliya P, Platt L, Dascombe B, Kumar R, Selvadurai H, Robinson PD, Mattes J. Exercise capacity is not decreased in children who have undergone lung resection early in life for congenital thoracic malformations compared to healthy age-matched children. Pediatr Pulmonol 2017; 52:1340-1348. [PMID: 28737279 DOI: 10.1002/ppul.23772] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/28/2017] [Indexed: 11/05/2022]
Abstract
PURPOSE The purpose of this study was to compare (i) the exercise capacity and (ii) lung function prior to and immediately post cardiopulmonary exercise tests (CPET) of children who underwent early life lung resection for Congenital Pulmonary Airway Malformations (CPAM) to healthy control children. METHOD Eight children with CPAM (four males, age 9.6 ± 1.8 years) and eight control children without respiratory disease (three males, age 9.4 ± 1.4 years) performed a CPET on a cycle ergometer, during which maximal oxygen consumption (V̇O2max ) and heart rate were measured. Prior to and immediately post CPET, lung function measures including Nitrogen Multiple Breath Washout (MBW) and spirometry were performed. RESULTS There were no significant between group differences in pre CPET lung function (P > 0.05) or maximal exercise capacity (V̇O2max CPAM: 39.4 mL. kg-1. min-1 , Control: 40.5 mL. kg-1. min-1 ). Post CPET, FEV1 was significantly lower in the CPAM group, with two participants diagnosed subsequently with exercise induced bronchospasm based on post-CPET spirometry and follow-up clinical investigations. CONCLUSION Early life lung resection for CPAM does not appear to have negative implications for exercise capacity later in childhood. Clinicians should be aware that dyspnoea following exercise may be due to asthma rather than residual effects of CPAM in these children.
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Affiliation(s)
- Ashlee Dunn
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, New South Wales, Australia.,Department of Paediatric Respiratory and Sleep Medicine, John Hunter Children's Hospital, Hunter New England Local Health District, New Lambton Heights, New South Wales, Australia
| | - Kasey Pearce
- Department of Paediatric Respiratory and Sleep Medicine, John Hunter Children's Hospital, Hunter New England Local Health District, New Lambton Heights, New South Wales, Australia.,Priority Research Centre GrowUpWell®, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, New South Wales, Australia
| | - Robin Callister
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, New South Wales, Australia
| | - Adam Collison
- Priority Research Centre GrowUpWell®, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, New South Wales, Australia
| | - Matthew Morten
- Priority Research Centre GrowUpWell®, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, New South Wales, Australia
| | - Payal Mandaliya
- Department of Paediatric Respiratory and Sleep Medicine, John Hunter Children's Hospital, Hunter New England Local Health District, New Lambton Heights, New South Wales, Australia.,The Westmead Children's Hospital, New South Wales, Australia
| | - Lauren Platt
- Department of Paediatric Respiratory and Sleep Medicine, John Hunter Children's Hospital, Hunter New England Local Health District, New Lambton Heights, New South Wales, Australia
| | - Ben Dascombe
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, New South Wales, Australia.,School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Rajendra Kumar
- Department of Paediatric Respiratory and Sleep Medicine, John Hunter Children's Hospital, Hunter New England Local Health District, New Lambton Heights, New South Wales, Australia
| | | | - Paul D Robinson
- The Westmead Children's Hospital, New South Wales, Australia
| | - Joerg Mattes
- Department of Paediatric Respiratory and Sleep Medicine, John Hunter Children's Hospital, Hunter New England Local Health District, New Lambton Heights, New South Wales, Australia.,Priority Research Centre GrowUpWell®, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, New South Wales, Australia
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6
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Shibuya S, Nakamura T, Miyazaki E. Anatomical Segmentectomy with a Hybrid VATS Approach in a Patient with Intralobar Pulmonary Sequestration after Severe Pneumonia: A Case Report. European J Pediatr Surg Rep 2017; 5:e21-e25. [PMID: 28680790 PMCID: PMC5496814 DOI: 10.1055/s-0037-1603592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 04/24/2017] [Indexed: 10/25/2022] Open
Abstract
Anatomical segmentectomy is an advantageous procedure because it spares healthy lung that has potential to show compensatory growth after lung resection and decreases the risk of air leak and residual resection, which becomes a problem in wedge resection. However, anatomical segmentectomy has not become a common procedure in pediatrics because it requires more complicated procedure than lobectomy or wedge resection, especially in patients with a history of pulmonary infection. In this case report, anatomical basal segmentectomy was safely performed with magnified vision by a hybrid video-assisted thoracic surgery (VATS) approach in a 6-year-old girl with intralobar pulmonary sequestration after severe pneumonia. The result suggests that the indications for hybrid VATS segmentectomy can expand further to include segmental lesions in children.
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Affiliation(s)
- Soichi Shibuya
- Department of Pediatric General and Urogenital Surgery, Juntendo University, Tokyo, Japan.,Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Toru Nakamura
- Department of Thoracic Surgery, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Eiji Miyazaki
- Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
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Calzolari F, Braguglia A, Valfrè L, Dotta A, Bagolan P, Morini F. Outcome of infants operated on for congenital pulmonary malformations. Pediatr Pulmonol 2016; 51:1367-1372. [PMID: 27232731 DOI: 10.1002/ppul.23472] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 04/05/2016] [Accepted: 05/02/2016] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Patients operated on for congenital pulmonary malformations (CPM) have excellent survival rates, but little is known about long-term morbidity. Our aim is to report the sequelae in patients operated on for CPM in infancy and to define factors that may influence their outcome. METHODS All patients operated on for major congenital anomalies are followed in a dedicated outpatient program and evaluated at 6, 24, and 48 months of life (corrected for gestational age) and at school age at 4, 6, 8, and 12 years of life. The data are prospectively collected. Patients operated on for CPM and enrolled in the follow-up clinic between January 2004 and December 2010 are compared with a control group of term infants operated on for inguinal hernia, without other major congenital or acquired abnormalities. The two groups were compared for auxological, respiratory, and orthopedic outcome. RESULTS In the study period, 76 consecutive patients with CPM attended our dedicated follow-up clinic. Eight non-operated patients were excluded from the study. Age at follow-up was 82.0 (56.1-103.7) months in CPM patients and 83.5 (75.2-90.4) months in controls (P = 0.79). Fifty-three patients with CPM (78%) had one or more clinical or radiological abnormality versus six (16%) control patients (OR [95%CI] 16.5 [5.8-47.2]; P < 0.0001). CONCLUSIONS Over 50% of patients with CPM present long-term sequelae, regardless type of malformation. Therefore, long-term follow-up of patients operated on for CPM is recommended. Further studies are needed to define if, in asymptomatic patients, surgery may modify the natural history of CPM. Pediatr Pulmonol. 2016;51:1367-1372. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Flaminia Calzolari
- Department of Medical and Surgical Neonatology, Neonatal Intensive Care Unit, Bambino Gesù Children's Research Hospital IRCCS, Piazza S. Onofrio, 4 00165, Rome, Italy
| | - Annabella Braguglia
- Department of Medical and Surgical Neonatology, Neonatal Intensive Care Unit, Bambino Gesù Children's Research Hospital IRCCS, Piazza S. Onofrio, 4 00165, Rome, Italy
| | - Laura Valfrè
- Department of Medical and Surgical Neonatology, Neonatal Surgery Unit, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
| | - Andrea Dotta
- Department of Medical and Surgical Neonatology, Neonatal Intensive Care Unit, Bambino Gesù Children's Research Hospital IRCCS, Piazza S. Onofrio, 4 00165, Rome, Italy
| | - Pietro Bagolan
- Department of Medical and Surgical Neonatology, Neonatal Surgery Unit, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
| | - Francesco Morini
- Department of Medical and Surgical Neonatology, Neonatal Surgery Unit, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
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Denbo JW, Zhu L, Srivastava D, Stokes DC, Srinivasan S, Hudson MM, Ness KK, Robison LL, Neel M, Rao B, Navid F, Davidoff AM, Green DM. Long-term pulmonary function after metastasectomy for childhood osteosarcoma: a report from the St Jude lifetime cohort study. J Am Coll Surg 2014; 219:265-71. [PMID: 24795268 PMCID: PMC4308956 DOI: 10.1016/j.jamcollsurg.2013.12.064] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 11/25/2013] [Accepted: 12/17/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Complete resection of lung metastases improves survival in patients with osteosarcoma. We evaluated the long-term effect of metastasectomy on pulmonary function of patients treated for osteosarcoma during childhood. STUDY DESIGN We reviewed the medical records of patients who had pulmonary function tests (PFTs) after metastasectomy for osteosarcoma. Patient, tumor, and treatment variables were abstracted along with PFTs. The PFTs were recorded as a percentage of predicted value and were classified as abnormal for forced vital capacity (FVC) < 80%, forced expiratory volume in 1 second (FEV1) < 80%, total lung capacity (TLC) < 75%, and single breath diffusion capacity for carbon monoxide corrected for hemoglobin (DLCOcorr) < 75%. RESULTS Twenty-one patients had PFTs performed during follow-up. Mean age at diagnosis of osteosarcoma was 13.2 ± 4.7 years (SD). Fifteen patients had a single thoracotomy, and 6 patients had ≥2 thoracotomies (range 2 to 6). Eighty lesions were resected. Nine patients had ≤2 lesions resected and 12 patients had >2 lesions (range 3 to 12) resected. Mean time from the last surgical procedure to measurement of PFTs was 20.3 ± 9.0 years (SD). Total lung capacity was abnormal for 28.6%, DLCOcorr for 47.4%, FVC for 40%, and FEV1 for 47.6% of the cohort members. Individual PFTs were abnormal in 13.3% (TLC) to 46.7% (DLCOcorr) of patients who had 1 thoracotomy and in 50.0% (DLCOcorr) to 66.7% (FEV1, TLC) of patients with ≥2 thoracotomies. The number of thoracotomies was associated with abnormal TLC (p = 0.03). CONCLUSIONS Patients who underwent pulmonary metastasectomy for osteosarcoma as children often had abnormal PFTs on long-term follow-up, but the reduction in lung volumes and DLCOcorr was relatively mild. Multiple thoracotomies predicted greater impairment of pulmonary function.
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Affiliation(s)
- Jason W Denbo
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN.
| | - Liang Zhu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - DeoKumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Dennis C Stokes
- Department of Pediatrics, University of Tennessee Health Science Center, and Program in Pediatric Pulmonary Medicine Le Bonheur Children's Hospital-St. Jude Children's Research Hospital, Memphis, TN
| | - Saumini Srinivasan
- Department of Pediatrics, University of Tennessee Health Science Center, and Program in Pediatric Pulmonary Medicine Le Bonheur Children's Hospital-St. Jude Children's Research Hospital, Memphis, TN
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Michael Neel
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - Bhaskar Rao
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - Fariba Navid
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - Daniel M Green
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
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