Thoracoscopic Segmentectomy for Congenital and Acquired Pulmonary Disease: A Case for Lung-Sparing Surgery

Abstract

Thoracoscopic lung-conserving therapy is technically feasible and safe in infants and children. The magnification provided by a thoracoscopic approach makes identification of segmental anatomic planes easier, aiding in safe dissection and resection. Anatomic resection appears to be associated with a low morbidity. It may be appropriate in the case of bilateral or extensive disease or in cases where the diseased tissue is clearly limited to an anatomic segment. Continued long-term follow-up is needed.

Congenital lung lesions: Postnatal management and outcome

“…Like many other authors, we have gone against the argument of lobectomy in all cases, as many of the lesions are small; some are bi-lobar and bilateral. [53][54][55] Late occurrence of malignancy in congenital lung lesion is not always restricted to CCAM and has also been reported in contralateral lung or within the normal residual ipsilateral lobe of the lung. 56,57 Adult surgeons are performing segmental resection for stage I and stage II lung carcinoma effectively and safely with comparable outcomes to lobectomy.…”

Morbidity after elective resection of prenatally diagnosed asymptomatic congenital pulmonary airway malformations

“…Traditionally most pediatric surgeons have recommended elective surgical excision during infancy but more recently some authors have suggested that expectant observation is also a reasonable approach . The controversy revolves around balancing the risks of CPAM, which include infection and cancer, against the risks of surgery and possible long‐term functional impairment associated with loss of pulmonary parenchyma . Although a number of authors have documented risks associated with pulmonary resection during childhood, there are few studies that have examined these risks specifically in the population of children with prenatally diagnosed asymptomatic CPAM.…”

“…[11][12][13] The controversy revolves around balancing the risks of CPAM, which include infection and cancer, against the risks of surgery and possible long-term functional impairment associated with loss of pulmonary parenchyma. 2,6,7,[14][15][16][17] Although a number of authors have documented risks associated with pulmonary resection during childhood, 9,[18][19][20][21][22] there are few studies that have examined these risks specifically in the population of children with prenatally diagnosed asymptomatic CPAM.…”

The Surgical Management Strategies in Congenital Pulmonary Airway Malformations: According to the Location of the Pulmonary Involvement

“…We performed surgery in an earlier stage of infancy, namely 1-6 months old to reduce the risk of later complications like respiratory infections and pneumothorax (18). Formal lobectomy is the most commonly accepted surgical option for CPAMs in the current medical era (3) although in recent years some authors have suggested lung-sparing techniques such as segmentectomy by thoracoscopy for these lesions (19,20). However, these strategies comprise an increased risk for an incomplete surgical excision.…”