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He T, Sun X, Luo D, Dai S, Yuan M, Yang G, Cheng K, Xu C. Absorbable Clips Applied in Thoracoscopic Anatomical Lung Resection in Younger Children. World J Surg 2023; 47:3394-3399. [PMID: 37851068 DOI: 10.1007/s00268-023-07193-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVES This study aims to evaluate the feasibility and safety of a 5-mm absorbable clips applied in thoracoscopic anatomical lung resection in younger children. METHODS Demographic data and intra- and postoperative parameters of the two groups (Abs-o-lock® group and Hem-o-lok® group) were reviewed. In the Abs-o-lock® group, 5-mm absorbable clips were used in thoracoscopic anatomical lung resection on all patients from January 2020 to March 2021. In the Hem-o-lok® group, 5-mm Hem-o-lok® clips were used from January to December 2019. The primary outcomes were the one-time success rate of ligation, major bleeding rate, intraoperative dislodgement rate and operative time, which were compared between the two groups. RESULTS There were 224 patients involved in this study, of whom 103 were in the Abs-o-lock® group and 121 were in the Hem-o-lok® group. The one-time success rate of ligation was 96.5% in the Abs-o-lock® group and 98.9% in the Hem-o-lok® group (p < 0.05). No major bleeding occurred in either group. The intraoperative dislodgement rate did not significantly differ between the two groups (p = 1.0). The operative time consumed in the Abs-o-lock® group was much longer than that in the Hem-o-lok® group for subgroups of resection of extralobar sequestration (p < 0.05), lobectomy (p < 0.05) and segmentectomy (p < 0.05). CONCLUSIONS Compared to Hem-o-lok® clips, it is feasible and safe to apply 5-mm absorbable clips for vessel sealing during thoracoscopic anatomical lung resection in younger children.
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Affiliation(s)
- Taozhen He
- Department of Pediatric Surgery, West China Hospital of Sichuan University, NO. 37 GUOXUE Lane, Chengdu, 610041, Sichuan Province, China
| | - Xiaoyan Sun
- Health Management Centre, West China Hospital of Sichuan University, NO. 37 GUOXUE Lane, Chengdu, 610041, China
| | - Dengke Luo
- Department of Pediatric Surgery, West China Hospital of Sichuan University, NO. 37 GUOXUE Lane, Chengdu, 610041, Sichuan Province, China
| | - Shiyi Dai
- Department of Pediatric Surgery, West China Hospital of Sichuan University, NO. 37 GUOXUE Lane, Chengdu, 610041, Sichuan Province, China
| | - Miao Yuan
- Department of Pediatric Surgery, West China Hospital of Sichuan University, NO. 37 GUOXUE Lane, Chengdu, 610041, Sichuan Province, China
| | - Gang Yang
- Department of Pediatric Surgery, West China Hospital of Sichuan University, NO. 37 GUOXUE Lane, Chengdu, 610041, Sichuan Province, China
| | - Kaisheng Cheng
- Department of Pediatric Surgery, West China Hospital of Sichuan University, NO. 37 GUOXUE Lane, Chengdu, 610041, Sichuan Province, China
| | - Chang Xu
- Department of Pediatric Surgery, West China Hospital of Sichuan University, NO. 37 GUOXUE Lane, Chengdu, 610041, Sichuan Province, China.
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2
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Kersten CM, Rousian M, Wesseling JJ, Sadeghi AH, Wijnen RMH, Schnater JM. Sublobar Pulmonary Resection in Children With Congenital Lung Abnormalities: A Systematic Review. J Pediatr Surg 2023; 58:2088-2097. [PMID: 37391296 DOI: 10.1016/j.jpedsurg.2023.05.030] [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: 02/13/2023] [Revised: 04/07/2023] [Accepted: 05/29/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Lobectomy is currently the advised resection for symptomatic congenital lung abnormalities (CLA). Sublobar surgery is suggested as an alternative that enables to conserve healthy lung parenchyma. This systematic review aims to explore the outcomes of sublobar surgery in CLA patients as well as the corresponding surgical terminology and techniques. METHODS A systematic literature search was performed in adherence to PRISMA-P guidelines. The target population consists of children undergoing sublobar pulmonary resection for CLA. All studies were independently assessed by two reviewers, and evaluated by a third reviewer in case of disagreement. RESULTS The literature search yielded 901 studies of which 18 studies were included, comprising 1167 cases. The median chest tube insertion duration was 3.6 days (range 2.0-6.9 days), the median hospital admission was 4.9 days (range 2.0-14.5 days), and residual disease was diagnosed in 2% - leading to re-operation in 70%. The median incidence of postoperative complications was 15% (range 0-67%). Follow-up imaging was standard-of-care in 2/3 of studies. Due to the absence of standardised terminology, operative details and specification of resection type did not typically relate between studies. CONCLUSIONS Sublobar resection of CLA lesions could be a viable alternative to lobectomy in certain cases, with the advantage of conserving healthy lung parenchyma. Peri- and postoperative complications are comparable with those reported for conventional lobectomy. The incidence of residual disease following sublobar surgery appears to be lower than commonly stated. To improve comparability between studies, we recommend reporting perioperative characteristics in a structured format. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Casper M Kersten
- Department of Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Merve Rousian
- Department of Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Jair J Wesseling
- Medicine Master's Student, Amsterdam UMC, Amsterdam, the Netherlands
| | - Amir H Sadeghi
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - Rene M H Wijnen
- Department of Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - J Marco Schnater
- Department of Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands.
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Huerta CT, Ramsey WA, Courel SC, Gilna GP, Saberi RA, Ribieras AJ, Perez EA, Sola JE, Thorson CM. Nationwide Outcomes After Thoracoscopic Versus Open Resection of Congenital Pulmonary Airway Malformations in Newborns. J Laparoendosc Adv Surg Tech A 2023; 33:897-903. [PMID: 37406288 DOI: 10.1089/lap.2023.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Purpose: Elective resection of congenital pulmonary airway malformations (CPAM) has been debated for decades and varies significantly between individual surgeons. However, few studies have compared outcomes and costs associated with thoracoscopic and open thoracotomy approaches on a national level. This study sought to compare nationwide outcomes and resource utilization in infants undergoing elective lung resection for CPAM. Materials and Methods: The Nationwide Readmission Database was queried from 2010 to 2014 for newborns who underwent elective surgical resection of CPAM. Patients were stratified by operative approach (thoracoscopic versus open). Demographics, hospital characteristics, and outcomes were analyzed using standard statistical tests. Results: A total of 1716 newborns with CPAM were identified. Elective readmission for pulmonary resection was performed in 12% (n = 198), with 63% of resections completed at a different hospital than the newborn stay. Most resections were thoracoscopic (75%), compared to only 25% via thoracotomy. Infants treated with thoracoscopic resection were more often male (78% versus 62% open, P = .040) and were older at the time of resection. Patients who had an open thoracotomy experienced a higher rate of serious complications (40% versus 10% thoracoscopic, P < .001), including postoperative hemorrhage, tension pneumothorax, and pulmonary collapse. Readmission costs were higher for infants treated via thoracotomy (P < .001). Conclusion: Thoracoscopic lung resection for CPAM is associated with lower cost and fewer postoperative complications than thoracotomy. Most resections are performed at different hospitals than the place of birth, which may affect long-term outcomes from single institutional studies. These findings may be used to address costs and improve future evaluations of elective CPAM resections.
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Affiliation(s)
- Carlos Theodore Huerta
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Walter A Ramsey
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Steve C Courel
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Gareth P Gilna
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Rebecca A Saberi
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Antoine J Ribieras
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Eduardo A Perez
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Juan E Sola
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Chad M Thorson
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
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Joo S, Yun T, Kang CH, Na KJ, Park S, Park IK, Kim YT. Thoracoscopic segmentectomy in children with congenital lung malformation. Sci Rep 2023; 13:9640. [PMID: 37316608 DOI: 10.1038/s41598-023-36700-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 06/08/2023] [Indexed: 06/16/2023] Open
Abstract
Congenital lung malformations (CLM) are most commonly treated with a pulmonary lobectomy. However, due to technological advancement, video-assisted thoracoscopic surgery (VATS) segmentectomy is becoming an attractive alternative to VATS lobectomy. This study aimed to evaluate the safety, feasibility, and efficacy of VATS segmentectomy as a lung parenchyma-saving strategy in children with CLM. A retrospective analysis was performed on 85 children, for whom VATS segmentectomy was tried for CLM between January 2010 and July 2020. We compared the surgical outcomes of VATS segmentectomy with the outcomes of 465 patients who underwent VATS lobectomy. Eighty-four patients received VATS segmentectomy and thoracotomy conversion was necessary for one patient for CLM. The mean age was 3.2 ± 2.5 (range 1.2-11.6) years. The mean operative time was 91.4 ± 35.6 (range 40-200) minutes. The median duration of chest tube drainage was 1 (range 1-21) day, and the median length of postoperative hospital stay was 4 (range 3-23) days. There were no postoperative mortality and postoperative complications developed in 7 patients (8.2%), including persistent air leakage in 6 patients (7.1%) and postoperative pneumonia in 1 patient (1.2%). The median follow-up period was 33.5 (interquartile range 31-57) months and there were no patients requiring re-intervention or reoperation during the follow-up period. In the VATS segmentectomy group, the persistent air leakage rate was higher than in the VATS lobectomy group (7.1 vs. 1.1%, p = 0.003). Otherwise, postoperative outcomes were comparable between the two groups. VATS segmentectomy in children with CLM is a technically feasible alternative to VATS lobectomy with acceptable early and mid-term outcomes. However, the persistent air-leakage rate was higher in VATS segmentectomy.
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Affiliation(s)
- Seohee Joo
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Taeyoung Yun
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
| | - Kwon Joong Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
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5
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Ahn S, Moon Y. Uniportal video-assisted thoracoscopic anatomical resection of the right anterior pulmonary segment in a 10-year-old child with congenital pulmonary airway malformation. J Cardiothorac Surg 2023; 18:188. [PMID: 37270524 DOI: 10.1186/s13019-023-02221-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/02/2023] [Indexed: 06/05/2023] Open
Abstract
Congenital pulmonary airway malformation (CPAM) is a very rare phenomenon subject to malignant transformation that requires surgical resection. In an asymptomatic 10-year-old girl, we identified a single cystic and consolidated lesion on computed tomography. This incidental finding was confined to anterior segment of lung in right upper lobe (RUL). Uniportal video-assisted thoracoscopic surgery (VATS) served to successfully achieve anterior segmentectomy, without chest tube placement. The surgical specimen confirmed features of CPAM, also showing acute and chronic inflammation with abscess formation. Once the surgical mainstay for such lesions, open lobectomy is now under challenge by thoracoscopic technique, port-reduction methods, and a lung-preserving strategy. Herein, we have shown uniportal VATS anatomical resection of right anterior pulmonary segment to be a viable option for a 10-year-old child with CPAM confined to a single lung segment.
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Affiliation(s)
- Seha Ahn
- Department of Thoracic & Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - Youngkyu Moon
- Department of Thoracic & Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea.
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6
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Ten-year experience in the clinical management of intralobar pulmonary sequestration in children. Pediatr Pulmonol 2023; 58:1022-1027. [PMID: 36539260 DOI: 10.1002/ppul.26287] [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: 09/21/2022] [Revised: 12/01/2022] [Accepted: 12/18/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Intralobar pulmonary sequestration (ILS) is rare and its optimal clinical management remains ambiguous. This study aimed to introduce our 10-year experience in clinical management of ILS. And the application of our novel surgical method, thoracoscopic anatomical lesion resection (TALR) on ILS was introduced. MATERIALS AND METHODS Patients with ILS who received treatment between December 2010 and 2020 were included in this study, retrospectively. A binary logistic regression model was used to assess risk factors for preoperative symptoms. Intraoperative and postoperative outcomes were compared between the thoracoscopic lobectomy and lung-sparing surgery groups. RESULTS A total of 112 patients were included in this study. Age and maximum cyst diameter were risk factors for preoperative symptoms. Lung-sparing surgery proved to be safe and feasible with no residual lesions. CONCLUSIONS The overall prognosis of early thoracoscopic surgery for ILS was good. Lung-sparing surgery, especially TALR could be used as a first-line surgery for ILS. It may resolve the long-standing controversy over whether surgery for asymptomatic patients with ILS.
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7
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King A, Olutoye OO, Lee TC, Keswani SG. Surgical Management of Congenital Lung Malformations. Neoreviews 2023; 24:e84-e96. [PMID: 36720690 DOI: 10.1542/neo.24-2-e84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Congenital lung malformations (CLMs) are commonly diagnosed prenatal lesions with varied natural history. Prenatal diagnosis and monitoring help to guide fetal interventions, delivery planning, and need for urgent perinatal surgical interventions. All prenatally diagnosed CLMs should be evaluated postnatally, typically with cross-sectional imaging, because many lesions persist despite the appearance of complete 'regression' in utero. Management of CLMs in asymptomatic infants weighs the surgical and anesthetic risk of prophylactic resection against the risk of expectant management, including the possibility of infection, malignant degeneration, and more complicated surgical resection later with loss of compensatory lung growth.
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Affiliation(s)
- Alice King
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.,Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX.,Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX
| | - Oluyinka O Olutoye
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Timothy C Lee
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.,Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX.,Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX
| | - Sundeep G Keswani
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.,Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX.,Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX
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8
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Cheng K, Liu X, Yuan M, Yang G, He T, Luo D, Liu C, Xu C. Thoracoscopic anatomic pulmonary segmentectomy for the treatment of congenital lung malformation in children. Asian J Surg 2023; 46:532-538. [PMID: 35780025 DOI: 10.1016/j.asjsur.2022.06.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/28/2022] [Accepted: 06/10/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lung-sparing surgery has been used to treat congenital lung malformation in children, and segmentectomy has been advocated as a lung-preservation strategy. However, thoracoscopic pulmonary segmentectomy has gained limited popularity considering the complications, the potential for residual lesions, and the technical difficulties associated with this procedure. Therefore, this study aimed to investigate the safety and feasibility of pediatric thoracoscopic anatomic pulmonary segmentectomy for the treatment of congenital lung malformations. METHODS We conducted a retrospective review of the medical records of 568 patients who were treated at West China Hospital, Sichuan University, from January 2014 to January 2020. The patients were divided into segmentectomy and lobectomy groups according to the surgical procedures they underwent. Clinical and follow-up outcomes were compared between the two groups. RESULTS The segmentectomy and lobectomy groups included 206 and 361 cases, respectively. The mean intraoperative blood loss was significantly higher in the segmentectomy group (6.9 mL vs. 4.5 mL; p = 0.03). The mean surgical time was also significantly longer in the segmentectomy group, (55.6 min vs. 41.5 min; p = 0.018). However, the incidence of complications did not differ significantly between the two groups (2.9% vs. 1.1%, p = 0.21). Patients in both groups did not require reoperation or show residual lesions during hospitalization and follow-up. CONCLUSIONS Thoracoscopic anatomic pulmonary segmentectomy is a safe and feasible definitive lung-sparing treatment for specific cases of congenital lung malformation, and has a complication rate comparable to that of thoracoscopic lobectomy.
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Affiliation(s)
- Kaisheng Cheng
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China
| | - Xiaojuan Liu
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, China
| | - Miao Yuan
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China
| | - Gang Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China
| | - Taozhen He
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China
| | - Dengke Luo
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China
| | - Chenyu Liu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China
| | - Chang Xu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China.
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Luo D, Fu X, Wang Q, Cheng K, Lv Y, Yuan M, Xu C, He T, Yang G, Wang Y, Jia R, Liu C. Thoracoscopic Clockwise Lobectomy May Be a Stylized Procedure for Treating Children with Congenital Lung Malformations. J Laparoendosc Adv Surg Tech A 2022; 32:1293-1298. [PMID: 36257641 DOI: 10.1089/lap.2022.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Thoracoscopic lobectomy is a challenging procedure in children with congenital lung malformations (CLMs). This study aims to evaluate the safety and efficacy of thoracoscopic clockwise lobectomy (TCL) in CLMs in children and its potential to be a stylized procedure. Methods: All patients with CLMs who received TCL from 2015 to 2019 in our hospital were retrospectively reviewed. Clinical information was extracted from medical records, including patient demographics, operative details, and outcomes. Results: A total of 184 patients with a median age of 6.8 months (range, 3-156) and a median weight of 9 kg (range, 6-45) received TCL. Lesions were all located in the lower lobe and included congenital pulmonary airway malformation (n = 133), intralobar sequestration (n = 44), bronchiectasis (n = 4), and congenital lobar emphysema (n = 3). The mean (±standard deviation [SD]) operating time was 46 ± 7.5 minutes (range, 35-113). The mean (±SD) blood loss was 3.5 ± 0.8 mL (range, 1-60). Three patients converted to thoracotomy, and 162 patients did not have a chest tube placed. The postoperative course was uneventful in all patients except 2 patients who developed air leaks and 23 patients who developed a mild fever. The median length of postoperative hospital stay was 2 days. A total of 163 patients were followed up for more than 1 year without any complications. Conclusion: TCL is suitable for lower lobectomy and is safe and effective in standard and complicated thoracoscopic lobectomy. It could be recommended as a stylized procedure in treating children with CLMs.
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Affiliation(s)
- Dengke Luo
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoying Fu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qinghai Wang
- Department of Pediatric Surgery, Guangyuan Central Hospital, Guangyuan, China
| | - Kaisheng Cheng
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Lv
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Miao Yuan
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chang Xu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Taozhen He
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Gang Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yao Wang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ru Jia
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chenyu Liu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
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10
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Accarain AA, Laureys M, Joyeux L, Damry N, Steyaert H, Reusens H. Arterial Embolization and Methylene Blue Injection into the Aberrant Artery in Two Infants with Intralobar Sequestration. European J Pediatr Surg Rep 2022; 10:e141-e144. [PMID: 36225531 PMCID: PMC9550518 DOI: 10.1055/s-0042-1757570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 03/02/2022] [Indexed: 11/25/2022] Open
Abstract
Bronchopulmonary sequestration is a rare congenital lung dysplasia. An intralobar sequestration (ILS) is a nonfunctional mass within the lung parenchyma without bronchial communication and with aberrant systemic arterial blood supply. Surgical resection or close observation can be proposed in the management of asymptomatic and low-risk ILS, but there is a lack of consensus. Endovascular embolization before thoracoscopic resection of ILS has been described to limit perioperative bleeding. Another technique previously reported is the injection of methylene blue in the feeding artery to macroscopically mark the sequestration from the healthy lung. In that way, a nonanatomical resection can be performed instead of a lobectomy without the risk of leaving abnormal lung tissue in place. We describe the first two cases of these two techniques combined: a 3-year-old girl with an ILS in the right lower lobe with an artery originating from the abdominal aorta, and a 14-month-old girl with an ILS in the right lower lobe with an artery coming from the celiac trunk. The combination of embolization and injection of methylene blue in the aberrant artery leads to a clear macroscopic demarcation of the blue-colored ILS from the healthy lung parenchyma and allowed safe nonanatomical resection of the ILS without risk of bleeding or compromising normal lung tissue.
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Affiliation(s)
- Anna Ayako Accarain
- Department of Surgery, Université Libre de Bruxelles, Brussels, Belgium,Address for correspondence Dr. Anna Ayako Accarain Department of Surgery, Université Libre de BruxellesRte de Lennik 808, Brussels 1010Belgium
| | - Marc Laureys
- Department of Radiology, Brugmann University Hospital, Brussels, Belgium
| | - Luc Joyeux
- Department of Pediatric Surgery, Hopital Universitaire des Enfants Reine Fabiola, Bruxelles, Belgium
| | - Nasroola Damry
- Department of Radiology, Brugmann University Hospital, Brussels, Belgium
| | - Henri Steyaert
- Department of Pediatric Surgery, Hopital Universitaire des Enfants Reine Fabiola, Bruxelles, Belgium
| | - Helena Reusens
- Department of Pediatric Surgery, Hopital Universitaire des Enfants Reine Fabiola, Bruxelles, Belgium
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Shu B, Feng X, Martynov I, Lacher M, Mayer S. Pediatric Minimally Invasive Surgery-A Bibliometric Study on 30 Years of Research Activity. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9081264. [PMID: 36010154 PMCID: PMC9406539 DOI: 10.3390/children9081264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022]
Abstract
Background: Pediatric minimally invasive surgery (MIS) is a standard technique worldwide. We aimed to analyze the research activity in this field. Methods: Articles on pediatric MIS (1991−2020) were analyzed from the Web of Science™ for the total number of publications, citations, journals, and impact factors (IF). Of these, the 50 most cited publications were evaluated in detail and classified according to the level of evidence (i.e., study design) and topic (i.e., surgical procedure). Results: In total, 4464 publications and 53,111 citations from 684 journals on pediatric MIS were identified. The 50 most cited papers were published from 32 institutions in the USA/Canada (n = 28), Europe (n = 19), and Asia (n = 3) in 12 journals. Four authors (USA/Europe) contributed to 26% of the 50 most cited papers as first/senior author. Hot topics were laparoscopic pyeloplasty (n = 9), inguinal hernia repair (n = 7), appendectomy, and pyloromyotomy (n = 4 each). The majority of publications were retrospective studies (n = 33) and case reports (n = 6) (IF 5.2 ± 3.2; impact index 16.5 ± 6.4; citations 125 ± 39.4). They were cited as often as articles with high evidence levels (meta-analyses, n = 2; randomized controlled trials, n = 7; prospective studies, n = 2) (IF 12.9 ± 22.5; impact index 14.0 ± 6.5; citations 125 ± 34.7; p > 0.05). Conclusions: Publications on laparoscopic pyeloplasty, inguinal hernia repair, appendectomy, and pyloromyotomy are cited most often in pediatric MIS. However, the relevant number of studies with strong evidence for the advantages of MIS in pediatric surgery is missing.
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12
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Yuan M, Xu C, Luo D, Cheng K, Yang G, He T. A Novel Surgical Method for Congenital Lung Malformations: A Pilot Study. Semin Thorac Cardiovasc Surg 2022; 35:541-547. [PMID: 35809837 DOI: 10.1053/j.semtcvs.2022.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 02/08/2023]
Abstract
Thoracoscopic surgery for congenital lung malformations (CLMs) has been widely used. However, there are still many shortcomings in the current surgical methods, such as the removal of some normal lung tissue and residual lesions. Thoracoscopic anatomical lesion resection (TALR) may be an effective and safe method to resolve these problems. This retrospective study was conducted to estimate the safety and efficiency of TALR. A retrospective review of clinical data involving patients who underwent TALR in our hospital from October 2019 to January 2021 was performed. Clinical data, including patients' demographic characteristics, manipulative details, and postoperative complications, were extracted and analyzed. A total of 95 cases were included in this study. All cases were operated on under thoracoscope, with no conversion to open surgery. The average operation time was 63.2 ± 15.2 min (range 36-142 min). The average bleeding volume during the operation was 5.8 ± 2.1 mL (range 2-10 mL). The mean diameter of the lesion was 4.4 ± 1.9 cm (range 3-7 cm). All cases had no complications, such as bronchopleurothelial fistula, hemorrhage, atelectasis, or pulmonary infection. Two patients developed pneumothorax 1 month after the operation and were cured by closed thoracic drainage. One month after the operation, chest CT showed regular cysts in 2 cases. The other patients were followed up for over 1 year by chest CT after the operation, and all recovered well without residual lesions or recurrence. Combined with the preoperative thin slice CT and intraoperative lesion boundary, anatomical intrapulmonary dissociation based on the pulmonary vein system, TALR, as a lung-sparing surgery of completely removing the lesion and retaining all normal lung tissue, has high safety and effectiveness in the treatment of CLMs.
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Affiliation(s)
- Miao Yuan
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, China
| | - Chang Xu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, China.
| | - Dengke Luo
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, China
| | - Kaisheng Cheng
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, China
| | - Gang Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, China
| | - Taozhen He
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, China
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Lin Z, Wu W, Ge H, Hu X, Zhao Q, Xia J. Comparison of single-port, multi-port video-assisted thoracoscopic and open lobectomy for children: a single-center experience. Pediatr Surg Int 2022; 38:415-421. [PMID: 34783877 DOI: 10.1007/s00383-021-05041-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The feasibility of single-port video-assisted thoracic surgery (SPVATS) for pediatric lobectomy has not been clearly established. We compared the feasibilities of single-port (SP), multi-port (MP) VATS and open lobectomy (OL) for surgical treatment of children with lung disease. METHODS In this study, we retrospectively analyzed and compared data for 22,19 and 30 pediatric lung disease patients who had been subjected to SP, MP and OL, respectively. These procedures were performed between March, 2012 and August, 2020 at the Second Affiliated Hospital of Wenzhou Medical University. Perioperative clinical indicators were analyzed. RESULTS Compared to OL, SP was associated with lower intraoperative blood loss (p = 0.008), lower postoperative thoracic drainage volume (p = 0.041), shorter chest drainage duration (p = 0.002) and hospital stay (p = 0.001). Operation time (p = 0.437), volume of estimated blood loss (p = 0.979), conversion rate to thoracotomy (p = 0.861), total thoracic drainage volume (p = 0.824), duration of chest tube drainage (p = 0.543), length of hospital stay (p = 0.812) and incidences of postoperative complications were comparable in MP and SP groups. CONCLUSION SPVATS is a safe and feasible approach for lobectomy in pediatrics, with comparable postoperative clinical outcomes to MPVATS and better outcomes relative to OL. However, studies with large sample sizes in multicenter should be performed to verify our findings.
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Affiliation(s)
- Zhiyong Lin
- The Department of Cardiovascular and Thoracic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, People's Republic of China
| | - Weijia Wu
- The Department of Cardiovascular and Thoracic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, People's Republic of China
| | - Hanwei Ge
- The Department of Cardiovascular and Thoracic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, People's Republic of China
| | - Xingti Hu
- The Department of Pediatric Cardiovascular and Thoracic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109 College West Road, Lucheng District, Wenzhou, 325027, People's Republic of China
| | - Qifeng Zhao
- The Department of Cardiovascular and Thoracic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, People's Republic of China
| | - Jie Xia
- The Department of Pediatric Cardiovascular and Thoracic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109 College West Road, Lucheng District, Wenzhou, 325027, People's Republic of China.
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14
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Zeng J, Liang J, Li L, Liu W, Tang J, Yin X, Yin G. Surgical Treatment for Asymptomatic Congenital Pulmonary Airway Malformations in Children: Waiting or Not? Eur J Pediatr Surg 2021; 31:509-517. [PMID: 33641135 DOI: 10.1055/s-0040-1719057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Infection is undoubtedly the most important factor in influencing the timing and surgical strategy of congenital pulmonary airway malformation (CPAM) surgery. However, there have been no studies on the optimal timing of surgery for patients based on the probability of infection. The aim of this study was performed to explore the optimal timing of surgery of CPAM in children from the risk of infection. MATERIALS AND METHODS The correlation of age distribution and pulmonary infection of 237 children diagnosed by pathology from January 2012 to January 2020 in Guangzhou Women and Children's Medical Center were analyzed retrospectively. We defined the cases with preoperative computed tomographic findings of infection, pathological findings of large number of neutrophils, tissue cells, and abscess formation as the infection group. RESULTS The rate of infection in patients less than 2 years old was significantly lower than in patients over 2 years old (11.4% vs. 45.7%, p < 0.001). And the pulmonary lobectomy rate of patients with infection (29.0%) was significantly higher than in noninfected patients (17.2%) and whole patients (36.3%), p = 0.033. Patients with infection lose more blood during surgery (noninfected patients: 81.76 ± 13.14 mL, infected patients: 145.10 ± 25.39 mL, p = 0.027). The univariate analysis revealed that the infection rate of patients over 2 years old was 3.084 times that of patients ≤2 years old (odds ratio [OR]: 3.084, 95% confidence interval [CI]: 1.196-7.954; p = 0.020). The infection rate of CPAM types III and IV patients is lower than types I and II (OR: 0.531, 95% CI: 0.307-0.920; p = 0.024). CONCLUSION In consideration of the high risk of infection, lower minimally invasive surgery rate, an increased rate of pulmonary lobectomy, and more blood loss in patients over 2 years old, our study also supports early surgical treatment. Therefore, we suggest that for asymptomatic patients with CPAM I and CPAM II, surgical treatment should be performed when they are less than 2 years old, providing more options for surgical strategies and monitoring of CPAM patients.
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Affiliation(s)
- Jiahang Zeng
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jianhua Liang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Le Li
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Wei Liu
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jue Tang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Xiaoli Yin
- College of Life Science, South China Normal University, Guangzhou, China
| | - Guocai Yin
- College of Life Science, Jining Medical University, Jining, Shandong, China
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15
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Pairawan SS, Tagge EP, Sacks MA, Hashmi A, Radulescu A, Khan FA. Thoracoscopic segmentectomy for a large previously undiagnosed CPAM presenting as a spontaneous pneumothorax: A case report. Int J Surg Case Rep 2021; 87:106412. [PMID: 34560589 PMCID: PMC8473762 DOI: 10.1016/j.ijscr.2021.106412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/11/2021] [Accepted: 09/12/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Incidentally found congenital pulmonary airway malformations (CPAM) in older children are extremely rare and have traditionally been managed with minimally invasive versus open lobectomy of the affected lobe. Presentation of case In this report, we present a 11-year-old male who presented with a recurrent spontaneous pneumothorax and was found to have a large symptomatic CPAM confined to a single segment of the right lower lobe. The patient was successfully treated with thoracoscopic segmentectomy without any residual disease seen on follow up imaging. Discussion Minimally invasive thoracoscopic approach has many advantages over open approach including better pain control, reduced hospital length of stay, and decreased intraoperative blood loss. With increasing use of minimally invasive approaches, lung-sparing surgery has demonstrated to be a viable and an attractive option for definitive resection of CPAM, without compromising resection margins and/or future lung function. Conclusion This report demonstrates that minimally invasive lung-sparing surgical treatment of a large CPAM is feasible in older children. Older children with CPAM can present with a spontaneous pneumothorax. CPAM confined to a segment of a single lobe should be managed with segmentectomy. VATS segmentectomy for CPAM in older children can be successful.
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Affiliation(s)
- Seyed S Pairawan
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States of America
| | - Edward P Tagge
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States of America
| | - Marla A Sacks
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States of America
| | - Asra Hashmi
- Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA, United States of America
| | - Andrei Radulescu
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States of America
| | - Faraz A Khan
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States of America.
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Lima M, D'Antonio S, Salvo ND, Parente G, Randi B, Libri M, Gargano T, Ruggeri G, Catania VD. Is It Better to Operate Congenital Lung Malformations when Patients are Still Asymptomatic? J Indian Assoc Pediatr Surg 2021; 26:170-176. [PMID: 34321788 PMCID: PMC8286031 DOI: 10.4103/jiaps.jiaps_70_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/16/2020] [Accepted: 08/18/2020] [Indexed: 11/08/2022] Open
Abstract
Context: Congenital lung malformation (CLM) is a rare developmental anomaly of the lower respiratory tract. The purposes are to define if the presence of respiratory symptoms, in CLM may affect surgical outcomes and to define optimal timing for surgery in asymptomatic patients. Settings and Design: Retrospective review of patients with CLM from 2004 to 2018. Asymptomatic and symptomatic patients were compared. Moreover, asymptomatic patients were stratified according to age at surgery (< or >6 months). Subjects and Methods: Demographic data, prenatal diagnosis, symptoms, CLM's characteristics, operative and postoperative data were collected. Patients were divided into two groups based on the presence or none of respiratory symptoms. Statistical Analysis: Data were compared using the Fisher's exact test for qualitative values and Mann-Whitney test for quantitative values P < 0.05 was statistically significant. Results: One hundred and eighty-six patients were treated. Asymptomatic were 137 (74%), while symptomatic were 49 (26%). The most common presenting symptoms were respiratory distress (n = 30, 61%) followed by pneumonia (n = 18, 38%). Prenatal diagnosis of CLM was performed in 98% of asymptomatic patients compared to 30% of symptomatic (P = 0.001). Surgical excision was performed in all cases, and in 50% by thoracoscopy, without difference between the two groups. In 97% of all cases, a lung sparing surgery was performed without difference between the groups. Symptoms are significantly associated with older age, location in the upper lobe, and lobar emphysema. Length of stay in intensive care, postoperative complications, and reintervention rate were higher in the symptomatic group. Eighty-one asymptomatic patients underwent surgery <6 months of life; they had a lower rate of surgical complications (2%) compared with those >6 months (7%). Conclusions: The present study describes a comprehensive picture of CLM. In addition, we emphasize the role of early postnatal management and thoracoscopic surgery, also before 6 months of life, to prevent the onset of symptoms that are associated with worse outcomes.
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Affiliation(s)
- Mario Lima
- Pediatric Surgery Unit, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Simone D'Antonio
- Pediatric Surgery Unit, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Neil Di Salvo
- Pediatric Surgery Unit, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Giovanni Parente
- Pediatric Surgery Unit, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Beatrice Randi
- Pediatric Surgery Unit, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Michele Libri
- Pediatric Surgery Unit, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Tommaso Gargano
- Pediatric Surgery Unit, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Giovanni Ruggeri
- Pediatric Surgery Unit, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Italy
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17
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Huang J, Zhou C, Chen Q, Wu D, Hong J, Hong S. Thoracoscopic lobectomy for a 4-day-old neonate with a large congenital pulmonary airway malformation: a case report. J Cardiothorac Surg 2020; 15:159. [PMID: 32611350 PMCID: PMC7331191 DOI: 10.1186/s13019-020-01174-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Congenital pulmonary airway malformation is a rare congenital lung lesion. Infants with large Congenital pulmonary airway malformation can present with a series of serious symptoms. Surgery is still the main treatment. Thoracoscopic lobectomy for neonates is rarely reported. CASE PRESENTATION The authors report a case of a congenital pulmonary airway malformation located in the left lower lung of a 4-day-old female infant. Prenatally, the cystic adenomatoid malformation volume ratio was 2.99 according to ultrasound scan. After birth, thoracoscopic lobectomy was performed to alleviate respiratory failure and mediastinal hernia. The patient's clinical symptoms and the X-ray re-examination showed good postoperative recovery. CONCLUSIONS The purpose of this study is to indicate that a safe and effective minimally invasive surgery for the giant congenital pulmonary airway malformation is feasible, even for infants only 4 days old.
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Affiliation(s)
- Jinxi Huang
- Department of Cadiothoracic Surgery, Fujian Children's Hospital, 18 daoshan Road, Fuzhou City, Fujian Province, China
| | - Chaoming Zhou
- Department of Pediatric Surgery, Fujian Provincial Maternity and Children's Hospital, 18 daoshan Road, Fuzhou City, Fujian Province, China.
| | - Qiang Chen
- Department of Cardiothoracic Surgery, Fujian Provincial Maternity and Children's Hospital, 18 daoshan Road, Fuzhou City, Fujian Province, China
| | - Dianming Wu
- Department of Pediatric Surgery, Fujian Provincial Maternity and Children's Hospital, 18 daoshan Road, Fuzhou City, Fujian Province, China
| | - Junjie Hong
- Department of Cadiothoracic Surgery, Fujian Children's Hospital, 18 daoshan Road, Fuzhou City, Fujian Province, China
| | - Songming Hong
- Department of Cadiothoracic Surgery, Fujian Children's Hospital, 18 daoshan Road, Fuzhou City, Fujian Province, China
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18
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Abstract
Diagnosis and management of congenital lung malformations has evolved dramatically over the past several decades. Advancement in imaging technology has enabled earlier, more definitive diagnoses and, consequently, more timely intervention in utero or after birth, when indicated. These advancements have increased overall survival rates to around 95% from historical rates of 60%. However, further refinement of diagnostic technique and standardization of treatment is needed, particularly as the increased sensitivity of diagnostic imaging results in more frequent diagnoses. In this article, we provide an updated review of the diagnostic strategies, management, and prognosis of congenital lung malformations.
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Affiliation(s)
- Michael Zobel
- Fetal Treatment Center, Department of Surgery, University of California, San Francisco
| | - Rebecca Gologorsky
- Fetal Treatment Center, Department of Surgery, University of California, San Francisco
| | - Hanmin Lee
- Fetal Treatment Center, Department of Surgery, University of California, San Francisco
| | - Lan Vu
- Fetal Treatment Center, Department of Surgery, University of California, San Francisco.
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19
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Annunziata F, Bush A, Borgia F, Raimondi F, Montella S, Poeta M, Borrelli M, Santamaria F. Congenital Lung Malformations: Unresolved Issues and Unanswered Questions. Front Pediatr 2019; 7:239. [PMID: 31249823 PMCID: PMC6584787 DOI: 10.3389/fped.2019.00239] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/28/2019] [Indexed: 12/30/2022] Open
Abstract
Advances in prenatal and postnatal diagnosis, perioperative management, and postoperative care have dramatically increased the number of scientific reports on congenital thoracic malformations (CTM). Nearly all CTM are detected prior to birth, generally by antenatal ultrasound. After delivery, most infants do well and remain asymptomatic for a long time. However, complications may occur beyond infancy, including in adolescence and adulthood. Prenatal diagnosis is sometimes missed and detection may occur later, either by chance or because of unexplained recurrent or persistent respiratory symptoms or signs, with difficult implications for family counseling and substantial delay in surgical planning. Although landmark studies have been published, postnatal management of asymptomatic children is still controversial and needs a resolution. Our aim is to provide a focused overview on a number of unresolved issues arising from the lack of an evidence-based consensus on the management of patients with CTM. We summarized findings from current literature, with a particular emphasis on the vigorous controversies on the type and timing of diagnostic procedures, treatments and the still obscure relationship between CTM and malignancies, a matter of great concern for both families and physicians. We also present an algorithm for the assessment and follow-up of CTM detected either in the antenatal or postnatal period. A standardized approach across Europe, based on a multidisciplinary team, is urgently needed for achieving an evidence-based management protocol for CTM.
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Affiliation(s)
- Federica Annunziata
- Division of Paediatrics, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Andrew Bush
- Department of Paediatrics and Paediatric Respiratory Medicine, Imperial College and Royal Brompton Hospital, London, United Kingdom
| | - Francesco Borgia
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Francesco Raimondi
- Division of Paediatrics, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Silvia Montella
- Division of Paediatrics, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Marco Poeta
- Division of Paediatrics, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Melissa Borrelli
- Division of Paediatrics, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Francesca Santamaria
- Division of Paediatrics, Department of Translational Medical Sciences, Federico II University, Naples, Italy
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20
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Mariani A, Peycelon M, Clermidi P, Bellon M, Skhiri A, Bonnard A. Safety Assessment for Thoracoscopic Day Case Surgery in Children with Congenital Pulmonary Malformation. J Laparoendosc Adv Surg Tech A 2018; 28:1129-1134. [DOI: 10.1089/lap.2017.0721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Aurora Mariani
- Department of Pediatric Surgery, Robert Debré Hospital, AP-HP, Paris, France
| | - Matthieu Peycelon
- Department of Pediatric Surgery, Robert Debré Hospital, AP-HP, Paris, France
| | - Pauline Clermidi
- Department of Pediatric Surgery, Robert Debré Hospital, AP-HP, Paris, France
| | - Myriam Bellon
- Department of Anesthesiology, Robert Debré Hospital, AP-HP, Paris, France
| | - Alia Skhiri
- Department of Anesthesiology, Robert Debré Hospital, AP-HP, Paris, France
| | - Arnaud Bonnard
- Department of Pediatric Surgery, Robert Debré Hospital, AP-HP, Paris, France
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21
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Thoracoscopic Resection of Congenital Cystic Adenomatoid Malformation in a Patient With Fused Lung Fissure Using Hookwire. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:226-229. [PMID: 29912138 DOI: 10.1097/imi.0000000000000501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Thoracoscopic resection is being used more commonly for the treatment of congenital cystic adenomatoid malformation in neonates and infants. However, in the rare case of congenital cystic adenomatoid malformation with congenital absence of lung fissure, thoracoscopic lobectomy cannot be performed safely. Moreover, if the lung lesion is deep-seated and cannot be visualized on the pleural surface, wedge resection may result in residual lesion. Here, we reported our approach of thoracoscopic resection under hookwire guidance to tackle this problem.
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22
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Lau CT, Wong KKY. Thoracoscopic Resection of Congenital Cystic Adenomatoid Malformation in a Patient with Fused Lung Fissure Using Hookwire. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018. [DOI: 10.1177/155698451801300312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Chin-Tung Lau
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Kenneth K. Y. Wong
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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23
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Wong KKY, Flake AW, Tibboel D, Rottier RJ, Tam PKH. Congenital pulmonary airway malformation: advances and controversies. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 2:290-297. [PMID: 30169300 DOI: 10.1016/s2352-4642(18)30035-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/23/2017] [Accepted: 11/28/2017] [Indexed: 02/07/2023]
Abstract
Advances in antenatal screening have provided evidence that the prevalence of congenital pulmonary airway malformation is higher than previously thought. This means that, on a global scale, more congenital pulmonary airway malformations will be diagnosed and seen by clinicians across many different specialties. This increase poses new controversies and challenges for clinicians in terms of prenatal and postnatal management. Important and exciting research has begun to emerge in the past decade. This Review describes current understanding of the disease, the latest surgical developments, and highlights management issues and controversies, including the rationale and timing of surgical intervention, the choice of surgical approach, and long-term functional outcomes. In doing so, we attempt to provide a balanced management algorithm for readers.
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Affiliation(s)
- Kenneth K Y Wong
- Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
| | - Alan W Flake
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dick Tibboel
- Department of Paediatric Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Robbert J Rottier
- Department of Paediatric Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Paul K H Tam
- Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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24
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Leblanc C, Baron M, Desselas E, Phan MH, Rybak A, Thouvenin G, Lauby C, Irtan S. Congenital pulmonary airway malformations: state-of-the-art review for pediatrician's use. Eur J Pediatr 2017; 176:1559-1571. [PMID: 29046943 DOI: 10.1007/s00431-017-3032-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 09/30/2017] [Accepted: 10/04/2017] [Indexed: 02/06/2023]
Abstract
UNLABELLED Congenital pulmonary airway malformations or CPAM are rare developmental lung malformations, leading to cystic and/or adenomatous pulmonary areas. Nowadays, CPAM are diagnosed prenatally, improving the prenatal and immediate postnatal care and ultimately the knowledge on CPAM pathophysiology. CPAM natural evolution can lead to infections or malignancies, whose exact prevalence is still difficult to assess. The aim of this "state-of-the-art" review is to cover the recently published literature on CPAM management whether the pulmonary lesion was detected during pregnancy or after birth, the current indications of surgery or surveillance and finally its potential evolution to pleuro-pulmonary blastoma. CONCLUSION Surgery remains the cornerstone treatment of symptomatic lesions but the postnatal management of asymptomatic CPAM remains controversial. There are pros and cons of surgical resection, as increasing rate of infections over time renders the surgery more difficult after months or years of evolution, as well as risk of malignancy, though exact incidence is still unknown. What is known: • Congenital pulmonary airway malformations (CPAM) are rare developmental lung malformations mainly antenatally diagnosed. • While the neonatal management of symptomatic CPAM is clear and includes prompt surgery, controversies remain for asymptomatic CPAM due to risk of infections and malignancies. What is new: • Increased rate of infection over time renders the surgery more difficult after months or years of evolution and pushes for recommendation of early elective surgery. • New molecular or pathological pathways may help in the distinction of type 4 CPAM from type I pleuropulmonary blastoma.
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Affiliation(s)
- Claire Leblanc
- Department of Pediatric Pulmonology, APHP Hôpital Armand Trousseau, Paris, France
| | - Marguerite Baron
- Department of Pediatric Pulmonology, APHP Hôpital Armand Trousseau, Paris, France
| | - Emilie Desselas
- Department of Pediatric Pulmonology, APHP Hôpital Armand Trousseau, Paris, France
| | - Minh Hanh Phan
- Department of Pediatric Pulmonology, APHP Hôpital Armand Trousseau, Paris, France
| | - Alexis Rybak
- Department of Pediatric Pulmonology, APHP Hôpital Armand Trousseau, Paris, France
| | - Guillaume Thouvenin
- Department of Pediatric Pulmonology, APHP Hôpital Armand Trousseau, Paris, France.,UPMC Univ Paris 06, Centre de Recherche St Antoine Inserm UMRS.938, Sorbonne Universités, Paris, France
| | - Clara Lauby
- Department of Pediatric Pulmonology, APHP Hôpital Armand Trousseau, Paris, France
| | - Sabine Irtan
- UPMC Univ Paris 06, Centre de Recherche St Antoine Inserm UMRS.938, Sorbonne Universités, Paris, France. .,Department of Pediatric Surgery, APHP Hôpital Armand Trousseau, 26 avenue du Dr Arnold Netter, 75012, Paris, France.
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Treatment of congenital pulmonary airway malformations: a systematic review from the APSA outcomes and evidence based practice committee. Pediatr Surg Int 2017; 33:939-953. [PMID: 28589256 DOI: 10.1007/s00383-017-4098-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2017] [Indexed: 01/15/2023]
Abstract
PURPOSE Variation in management characterizes treatment of infants with a congenital pulmonary airway malformation (CPAM). This review addresses six clinically applicable questions using available evidence to provide recommendations for the treatment of these patients. METHODS Questions regarding the management of a pediatric patient with a CPAM were generated. English language articles published between 1960 and 2014 were compiled after searching Medline and OvidSP. The articles were divided by subject area and by the question asked, then reviewed and included if they specifically addressed the proposed question. RESULTS 1040 articles were identified on initial search. After screening abstracts per eligibility criteria, 130 articles were used to answer the proposed questions. Based on the available literature, resection of an asymptomatic CPAM is controversial, and when performed is usually completed within the first six months of life. Lobectomy remains the standard resection method for CPAM, and can be performed thoracoscopically or via thoracotomy. There is no consensus regarding a monitoring protocol for observing asymptomatic lesions, although at least one chest computerized tomogram (CT) should be performed postnatally for lesion characterization. An antenatally identified CPAM can be evaluated with MRI if fetal intervention is being considered, but is not required for the fetus with a lesion not at risk for hydrops. Prenatal consultation should be offered for infants with CPAM and encouraged for those infants in whom characteristics indicate risk of hydrops. CONCLUSIONS Very few articles provided definitive recommendations for care of the patient with a CPAM and none reported Level I or II evidence. Based on available information, CPAMs are usually resected early in life if at all. A prenatally diagnosed congenital lung lesion should be evaluated postnatally with CT, and prenatal counseling should be undertaken in patients at risk for hydrops.
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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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Lee S, Kim DH, Lee SK. Efficacy of segmental resection in patients with prenatally diagnosed congenital lung malformations. Interact Cardiovasc Thorac Surg 2017; 24:425-429. [PMID: 28040760 DOI: 10.1093/icvts/ivw408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 11/17/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives Lung segmental resection is a better treatment option than lobectomy for patients with prenatally diagnosed congenital lung malformations (CLMs). However, data are lacking on the effects of this procedure in prenatally diagnosed CLM patients. In this study, we explored whether parenchyma-saving resection was feasible in patients with this condition. Methods A retrospective analysis was performed on 27 patients prenatally diagnosed with CLM, who subsequently underwent surgery between March 2011 and September 2015. Lobectomies and segmental resections were performed in 7 and 20 patients, respectively, based on the extent of cystic lesion invasion. Results The operative time significantly differed between the two groups (lobectomy group, 92.9 ± 32.0 min; segmental resection group, 126.5 ± 37.5 min). However, the duration of chest tube drainage and the length of hospital stay did not significantly differ between the groups. Chest computed tomography (CT) was performed during follow-up on all but 3 patients. We encountered 2 cases of remnant lesions, and one instance of a small emphysematous lesion around the surgical site was noted in either group. Conclusions Lung-sparing surgery is relatively safe with few complications. In this study, the incidence of remnant lung lesions (a drawback of segmentectomy) was low. Thus, segmental resection affords results similar to those of lobectomy in patients with prenatally diagnosed CLM. Furthermore, segmental resection can preserve lung volume, thereby maintaining later pulmonary function. Therefore, elective segmental resection performed after precise identification of the lesions' locations may be highly beneficial for CLM patients.
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Affiliation(s)
- Sungkwang Lee
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Kyungheedae-ro, Dongdaemun-gu, Seoul, Republic of Korea.,Department of Acupuncture and Moxibustion, Kyung Hee University Korean Medicine Hospital, Kyungheedae-ro, Dongdaemun-gu, Seoul, Republic of Korea
| | - Do Hyung Kim
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sang Kwon Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Does thoracoscopy have advantages over open surgery for asymptomatic congenital lung malformations? An analysis of 1626 resections. J Pediatr Surg 2017; 52:247-251. [PMID: 27889066 DOI: 10.1016/j.jpedsurg.2016.11.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/08/2016] [Indexed: 11/23/2022]
Abstract
AIM The apparent incidence of antenatally diagnosed congenital lung malformations (CLM) is rising (1 in 3000), and the majority undergo elective resection even if asymptomatic. Thoracoscopy has been popularized, but early series report high conversion rates and significant complications. We aimed to perform systematic review/meta-analysis of outcomes of thoracoscopic vs open excision of asymptomatic CLMs. METHODS A systematic review according to PRISMA guidelines was performed. Data were extracted for all relevant studies (2004-2015) and Rangel quality scores calculated. Analysis was on 'intention to treat' basis for thoracoscopy and asymptomatic lung lesions. Meta-analysis was performed using the addon package METAN of the statistical package STATA14™; p<0.05 was considered significant. RESULTS 36 studies were eligible, describing 1626 CLM resections (904 thoracoscopic, 722 open). There were no randomized controlled trials. Median quality score was 14/45 (IQR 6.5) 'poor'. 92/904 (10%) thoracoscopic procedures were converted to open. No deaths were reported. Meta-analysis showed that regarding thoracoscopic procedures, the total number of complications was significantly less (OR 0.63, 95% CI 0.43, 0.92; p<0.02, 12 eligible series, 912 patients, 404 thoracoscopic). Length of stay was 1.4days shorter (95%CI 2.40, 0.37;p<0.01). Length of operation was 37 min longer (95% CI 18.96, 54.99; p<0.01). Age, weight, and number of chest tube days were similar. There was heterogeneity (I2 30%, p=0.15) and no publication bias seen. CONCLUSIONS A reduced total complication rate favors thoracoscopic excision over thoracotomy for asymptomatic antenatally diagnosed CLMs. Although operative time was longer, and open conversion may be anticipated in 1/10, the overall length of hospital stay was reduced by more than 1day. LEVEL OF EVIDENCE 4 (based on lowest level of article analyzed in meta-analysis/systematic review).
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Wagenaar AE, Tashiro J, Satahoo SS, Sola JE, Neville HL, Hogan AR, Perez EA. Resection of pediatric lung malformations: National trends in resource utilization & outcomes. J Pediatr Surg 2016; 51:1414-20. [PMID: 27292597 DOI: 10.1016/j.jpedsurg.2016.04.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 04/24/2016] [Accepted: 04/28/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE We sought to determine factors influencing survival and resource utilization in patients undergoing surgical resection of congenital lung malformations (CLM). Additionally, we used propensity score-matched analysis (PSMA) to compare these outcomes for thoracoscopic versus open surgical approaches. METHODS Kids' Inpatient Database (1997-2009) was used to identify congenital pulmonary airway malformation (CPAM) and pulmonary sequestration (PS) patients undergoing resection. Open and thoracoscopic CPAM resections were compared using PSMA. RESULTS 1547 cases comprised the cohort. In-hospital survival was 97%. Mortality was higher in small vs. large hospitals, p<0.005. Survival, pneumothorax (PTX), and thoracoscopic procedure rates were higher, while transfusion rates and length of stay (LOS) were lower, in children ≥3 vs. <3months (p<0.001). Multivariate analysis demonstrated longer LOS for older patients and Medicaid patients (all p<0.005). Total charges (TC) were higher for Western U.S., older children, and Medicaid patients (p<0.02). PSMA for thoracoscopy vs. thoracotomy in CPAM patients showed no difference in outcomes. CONCLUSION CLM resections have high associated survival. Children <3months of age had higher rates of thoracotomy, transfusion, and mortality. Socioeconomic status, age, and region were independent indicators for resource utilization. Extent of resection was an independent prognostic indicator for in-hospital survival. On PSMA, thoracoscopic resection does not affect outcomes.
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Affiliation(s)
- Amy E Wagenaar
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jun Tashiro
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Shevonne S Satahoo
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Juan E Sola
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Holly L Neville
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Anthony R Hogan
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eduardo A Perez
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
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Lieber J, Urla CI, Baden W, Schäfer J, Kirschner HJ, Fuchs J. Experiences and challenges of thorcoscopic lung surgery in the pediatric age group. Int J Surg 2015; 23:169-75. [PMID: 26475091 DOI: 10.1016/j.ijsu.2015.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/12/2015] [Accepted: 10/04/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND We report a single-center study of minimally invasive thoracoscopic lung surgery with pediatric patients. METHODS We performed a retrospective analysis of patients who underwent thoracoscopic lung surgery between 2004 and 2013. The procedures were divided into anatomic and non-anatomical lung resections. RESULTS Seventy-six patients with a mean age of 6.5 years (range: 7 days-17 years) and a mean weight of 11 kg (range: 2.6-56.0 kg) received thoracoscopic lung surgery for tumor metastases (n = 20), sequestration/congenital adenomatoid malformation (19), cysts (12), aspergillomas (7), bullae (5), middle lobe syndrome (3), bronchiectasis (3), emphysema (2), and other reasons (5). Twenty-nine anatomical lung resections (Group I: lobectomies, segmentectomies) and 47 non-anatomical lung resections (Group II: wedge resections, lung tissue-sparing surgery) were performed. In 6 cases, preoperative CT-guided coiling was used to localize the lung lesions. Specimen removal was achieved using a widened (2 cm) trocar site. The operating times of Group I patients were longer compared than those of Group II patients (means: 154 and 68 min, respectively); conversion rates (8 versus 2), chest tube insertion rates (100% versus 51%), and postoperative ventilation (48% versus 13%) also differed. CONCLUSION Thoracoscopic anatomical lung resections appear to be safe and effective in infants and children. In congenital lung diseases, the key to success is the intraoperative destruction of space-occupying lesions. Limitations exist in cases with infectious adhesions. Non-anatomical lung resections are technically easier and should remain standard in pediatric surgery. Limitations exist in cases of metastases, which are deep within the parenchyma and are not visible on the lung surface.
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Affiliation(s)
- Justus Lieber
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Hoppe-Seyler-Strasse 1, D-72076 Tübingen, Germany.
| | - Cristian Ioan Urla
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Hoppe-Seyler-Strasse 1, D-72076 Tübingen, Germany.
| | - Winfried Baden
- Department of Pediatric Cardiology and Pulmonology, University Children's Hospital, Hoppe-Seyler-Strasse 1, D-72076 Tübingen, Germany.
| | - Jürgen Schäfer
- Department of Diagnostic Radiology, University Hospital, Hoppe-Seyler-Strasse 1, D-72076 Tübingen, Germany.
| | - Hans-Joachim Kirschner
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Hoppe-Seyler-Strasse 1, D-72076 Tübingen, Germany.
| | - Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Hoppe-Seyler-Strasse 1, D-72076 Tübingen, Germany.
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Kulaylat AN, Engbrecht BW, Hollenbeak CS, Safford SD, Cilley RE, Dillon PW. Comparing 30-day outcomes between thoracoscopic and open approaches for resection of pediatric congenital lung malformations: Evidence from NSQIP. J Pediatr Surg 2015; 50:1716-21. [PMID: 26144284 DOI: 10.1016/j.jpedsurg.2015.06.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 06/04/2015] [Accepted: 06/08/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND/PURPOSE Thoracoscopic surgery has been increasingly utilized in treating pediatric congenital lung malformations (CLM). Comparative studies evaluating 30-day outcomes between thoracoscopic and open resection of CLM are lacking. METHODS There were 258 patients identified in pediatric NSQIP with a CLM and pulmonary resection in 2012-2013. Comparisons of patient characteristics and outcomes between surgical approaches were made using standard univariate statistics. In addition, a propensity score match was performed to evaluate outcomes in similar patient cohorts. RESULTS One-hundred twelve patients (43.4%) received thoracoscopic resections and 146 patients (56.6%) received open resections. Patients undergoing open resections were more likely to be less than 5 months of age and have a comorbidity/preoperative condition (47.3% vs. 25.0%, p<0.001). The extent of resection was a lobectomy in 84.8% of thoracoscopic and 92.5% of open resection patients. Median operative time was similar between both groups (thoracoscopic 172 vs. open 153.5 minutes). On univariate analysis, thoracoscopic resection was associated with decreased postoperative complications (9.8% vs. 25.3%, p=0.001) and LOS (3 vs. 4 days, p<0.001). However, after adjusting for similar patient and operative characteristics, no significant differences were encountered between techniques. CONCLUSIONS Thoracoscopic and open resection provide comparable 30-day outcomes and safety in the management of congenital lung malformations.
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Affiliation(s)
- Afif N Kulaylat
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Brett W Engbrecht
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Christopher S Hollenbeak
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, United States; Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Shawn D Safford
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Robert E Cilley
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Peter W Dillon
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, United States.
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Choudhry M, Drake D. Antenatally diagnosed lung malformations: a plea for long-term outcome studies. Pediatr Surg Int 2015; 31:439-44. [PMID: 25556419 DOI: 10.1007/s00383-014-3654-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2014] [Indexed: 10/24/2022]
Abstract
There is a wide variation in the management of infants with antenatally diagnosed lung malformations, with many paediatric surgeons and respiratory paediatricians recommending early investigations for all infants and a surgical excision for the majority of lesions, while others favour a conservative management for all asymptomatic infants. The benefits and risks of a surgical intervention have to be compared with the natural history of the untreated malformation and cohort studies from foetal diagnosis to adult life are required to provide the relevant evidence. Careful and repeated surveillance of identified foetuses is essential as recent advances in foetal medicine and surgery have improved the outcomes for the small minority, who are at risk of developing hydrops.
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Affiliation(s)
- Muhammad Choudhry
- Department of Paediatric Surgery, Mater Dei Hospital, L-Imsida, Malta,
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Macias L, Ojanguren A, Dahdah J, Gossot D. Thoracoscopic anatomical resection of congenital lung malformations in adults. J Thorac Dis 2015; 7:486-9. [PMID: 25922729 DOI: 10.3978/j.issn.2072-1439.2015.01.50] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 12/04/2014] [Indexed: 11/14/2022]
Abstract
Congenital lung malformations (CLM) are a heterogeneous group of disorders that may require surgical resection to prevent complications. Thoracoscopic resection of CLM has been reported in infants. Our goal was to state whether it can also be a viable option in adults. Between 2007 and 2014, 11 patients had a thoracoscopic resection of a CLM (six lobectomies and five anatomic segmentectomies) with satisfactory results. Although being more challenging in adults due to infectious sequellae, this approach is safe.
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Affiliation(s)
- Lidia Macias
- Thoracic Department, Institut Mutualiste Montsouris, 42 Bd Jourdan, F-75014 Paris, France
| | - Amaia Ojanguren
- Thoracic Department, Institut Mutualiste Montsouris, 42 Bd Jourdan, F-75014 Paris, France
| | - Julien Dahdah
- Thoracic Department, Institut Mutualiste Montsouris, 42 Bd Jourdan, F-75014 Paris, France
| | - Dominique Gossot
- Thoracic Department, Institut Mutualiste Montsouris, 42 Bd Jourdan, F-75014 Paris, France
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Wagenaar AE, Tashiro J, Hirzel A, Rodriguez LI, Perez EA, Hogan AR, Neville HL, Sola JE. Surgical management of bronchopulmonary malformations. J Surg Res 2015; 198:406-12. [PMID: 25918001 DOI: 10.1016/j.jss.2015.03.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 02/22/2015] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Bronchopulmonary malformations (BPM) are rare conditions, which typically arise below the carina and can result in significant morbidity (infection and/or hemorrhage) and mortality (respiratory failure). MATERIALS AND METHODS All children with BPM surgically treated from 2001-2014 at a tertiary care children's hospital were identified. Patient demographics, surgical indications, procedure type, estimated blood loss, pathology, perioperative complications, length of stay, and outcomes were analyzed. RESULTS A total of 41 BPM patients underwent surgery with 98% overall survival (one abdominal BPM expired) but 100% for thoracic lesions. Resections were performed thoracoscopically (37%), thoracoscopy converted to open (22%), and via thoracotomy (37%). Poor visualization (67%) or inability to tolerate single lung ventilation (33%) led to conversions. No conversions resulted from hemorrhage or received blood transfusions. Patients with prenatally diagnosed BPM were more likely to undergo thoracoscopic surgery (odds ratio [OR], 18.2) versus nonprenatally diagnosed, P = 0.002. Open/converted patients had longer chest tube days (6.2) versus thoracoscopic (2.9), P = 0.048. Additionally, respiratory distress was a more common indication in patients aged <4 mo (OR, 28.0) versus ≥4 mo and <6 kg (OR, 40.5) versus ≥6 kg, P < 0.001. Open resections were more common in patients aged <4 mo (OR, 26.3) versus ≥4 mo, P = 0.002. Operative time was shorter and estimated blood loss (mL/kg) was greater for <6 versus ≥6 kg, P < 0.05. CONCLUSIONS BPM resections have high overall survival. Chest tube days are shorter among thoracoscopic patients, but conversion to thoracotomy can avoid hemorrhage and need for transfusion. Size and respiratory distress limit use of thoracoscopy in young infants with BPM.
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Affiliation(s)
- Amy E Wagenaar
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Jun Tashiro
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Alicia Hirzel
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Luis I Rodriguez
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Eduardo A Perez
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Anthony R Hogan
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Holly L Neville
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Juan E Sola
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida.
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Tarrado X, Saura L, Bejarano M, Ribó JM, Castañón M. Thoracoscopic Segmentectomy of Methylene Blue Dyed Intralobar Sequestrations. Ann Thorac Surg 2015; 99:e51-2. [DOI: 10.1016/j.athoracsur.2014.10.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 10/09/2014] [Accepted: 10/31/2014] [Indexed: 10/24/2022]
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Abstract
The management of congenital lung malformations is controversial both in the prenatal and postnatal periods. This article attempts to inform best practice by reviewing the level of evidence with regard to prenatal diagnosis, prognosis, and management and postnatal management, including imaging, surgical indication, surgical approach, and risk of malignancy. We present a series of clinically relevant statements along those topics and analyze the evidence for each. In the end, we make a plea for an adequate description of the lesions, both before and after birth, which will allow future comparisons between management options and the initiation of prospective registries.
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Affiliation(s)
- Robert Baird
- Department of Pediatric Surgery, McGill University, Montreal Children׳s Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Pramod S Puligandla
- Department of Pediatric Surgery, McGill University, Montreal Children׳s Hospital, McGill University Health Center, Montreal, QC, Canada; Department of Pediatrics, McGill University, Montreal Children׳s Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Jean-Martin Laberge
- Department of Pediatric Surgery, McGill University, Montreal Children׳s Hospital, McGill University Health Center, Montreal, QC, Canada.
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Wang A, D'Amico TA, Berry MF. Surgical Management of Congenital Pulmonary Malformations After the First Decade of Life. Ann Thorac Surg 2014; 97:1933-8. [DOI: 10.1016/j.athoracsur.2014.01.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 01/09/2014] [Accepted: 01/17/2014] [Indexed: 10/25/2022]
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Abstract
AIM To review the outcome of all antenatally diagnosed conservatively managed congenital lung malformations (CLMs) managed at our centre. METHODS All patients diagnosed antenatally with cystic lung malformations from 2001 to 2011, at a tertiary referral paediatric surgical centre practising a policy of conservative management of asymptomatic cases, were retrospectively reviewed. Data were collected from medical case notes and radiology reports. Ethical approval was obtained from our institutional research and development department. RESULTS The complete records of 74 fetuses antenatally diagnosed with CLM were reviewed. There were 72 live births, at a median gestation of 39.6 weeks. Emergency lobectomy was performed in one symptomatic neonate. Elective lobectomies were performed at parental request in three asymptomatic infants, one of whom had a family history of synovial sarcoma. Two patients developed pneumonia in the affected lobe during early childhood and proceeded to lobectomy at the age of 3 years. One patient with a bronchopulmonary sequestration required embolisation for cyanotic episodes. The remaining 65 patients have been conservatively managed to date, and none have required hospital admission. Less than a quarter report mild respiratory symptoms such as cough or wheeze. Median follow-up is 5 years. CONCLUSIONS This retrospective cohort study of 74 consecutive CLMs diagnosed antenatally over a 10-year period demonstrates that most of these lesions will remain asymptomatic throughout childhood. Although the natural history of CLMs in later years remains to be elucidated, we hope that this report on medium-term outcomes will be useful to clinicians who undertake antenatal counselling and may inform the discussion on how best to manage these children.
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Affiliation(s)
- Christabella Ng
- Department of Paediatric Surgery, University Hospital Southampton NHS Foundation Trust, , Southampton, UK
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39
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Rothenberg SS, Shipman K, Kay S, Kadenhe-Chiweshe A, Thirumoorthi A, Garcia A, Czauderna P, Kravarusic D, Freud E. Thoracoscopic Segmentectomy for Congenital and Acquired Pulmonary Disease: A Case for Lung-Sparing Surgery. J Laparoendosc Adv Surg Tech A 2014; 24:50-4. [DOI: 10.1089/lap.2013.0337] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Steven S. Rothenberg
- The Rocky Mountain Hospital for Children, Denver, Colorado
- Columbia University College of Physicians and Surgeons, New York, New York
| | | | - Saundra Kay
- The Rocky Mountain Hospital for Children, Denver, Colorado
| | | | - Arul Thirumoorthi
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Alejandro Garcia
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Piotr Czauderna
- Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland
| | - Dragan Kravarusic
- Schneider Children's Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Enrique Freud
- Schneider Children's Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Fascetti-Leon F, Gobbi D, Pavia SV, Aquino A, Ruggeri G, Gregori G, Lima M. Sparing-lung surgery for the treatment of congenital lung malformations. J Pediatr Surg 2013; 48:1476-80. [PMID: 23895957 DOI: 10.1016/j.jpedsurg.2013.02.098] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 01/16/2013] [Accepted: 02/20/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Congenital lung malformations (CLM) are traditionally treated by pulmonary lobectomy. The foremost indication for surgery is that these lesions predispose to respiratory tract infections and to malignancy. Owing to the improvement of prenatal diagnosis, most patients are operated in a timely manner and prophylactically. In this context, lung-sparing surgery (LS) has gained interest as a lung preservation strategy, especially for asymptomatic patients. In the present study, we evaluated both thoracoscopic and open lung-preserving resections as an alternative to lobectomy for CLM resection. METHODS We retrospectively reviewed all patients who underwent lung-sparing resection (segmentectomy and atypical resection) for CLM from 2001 to 2010. Data were collected regarding preoperative diagnostic workup, type of intervention, and follow up. RESULTS Fifty-four patients received LS for CLM during the study period. Twenty-six were approached thoracoscopically, with 18 cases requiring open conversion for a complete resection. There were six postoperative complications: three asymptomatic pneumothoraces that resolved without intervention, one tension pneumothorax that required replacement of a drainage catheter, and three instances of intra-operative bleeding requiring blood transfusion. Mean duration of follow-up was 65.2 months. Two patients experienced pneumonia during the follow-up period. A third patient had a cystic lung lesion on postoperative computed tomography (CT) which required a second-look surgery. CONCLUSIONS LS for CLM is a safe and effective means of lung parenchymal preservation in pediatric patients. Complication rates are comparable to that of traditional lobectomy. In our experience, this type of lung surgery does not carry a higher risk of residual disease and recurrence if accurately planned in selected patients, i.e., those with small asymptomatic lesions. The complication rate is acceptable and apparently not affected by preoperative symptoms. The thoracoscopic approach is recommended, although open conversion should be advocated to avoid too long operative times.
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Affiliation(s)
- Francesco Fascetti-Leon
- Department of Paediatric Surgery, Paediatric Surgery Unit, University of Bologna, Via Massarenti, 11, 40138, Bologna, Italy.
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Abstract
Confusion, controversy, and uncertainty are all terms applicable to the diagnosis and management of congenital lung lesions both prenatally and postnatally. This review examines the current status of fetal diagnosis and treatment of these lesions; reviews the various classifications, including congenital cystic adenomatoid malformation/congenital pulmonary airway malformation, sequestrations, variants and hybrid lesions; discusses the risk of malignant transformation or misdiagnosis with pleuropulmonary blastoma; presents the arguments in favor and against resection of asymptomatic lesions, the timing of such resection, and the long-term pulmonary function after resection; and reviews the experience with thoracoscopic resection of congenital lung lesions.
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