Thoracoscopy versus thoracotomy for congenital lung malformations treatment: A single center experience

Purpose: This study aimed to determine the complications after video assisted thoracoscopic surgery (VATS) for congenital lung lesions in children. Methods: All children undergoing a lung resection between January 2009 and June 2022 were retrospectively identified. Both early (<30 days) and late postoperative pulmonary complications were determined. The primary endpoint was postoperative complications within 30 days. Results: In total, 56 patients were included, with a median age of 13 months (IQR 9-37). A VATS lobectomy were performed in 46 patients (82%), an extralobar sequestration in 8 patients (14%), an wedge resection in 1 patient and a segment resection in 1 patient. During the COVID pandemic, less resections were performed with an increase in symptomatic patients. A conversion to open occurred in 6 patients (11%), of which a preoperative lung infection was associated with an increased risk thereof (p=0.004). The median follow-up was 22 months (IQR 7-57) and all patients were alive. A postoperative complication (Clavien Dindo ≥3) occurred in 9 patients and complications without the need of intervention in 6 patients. Conclusion: VATS lobectomy is a relatively safe procedure in children, even under one year of age. A preoperative lung infection increases the risk of conversion to open surgery.

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Section: Discussionsupporting

confidence: 92%

“…Conversion rates in thoracoscopic lobectomy has been reported between 0-33% [10][11][12]. In our study, the conversion rate was 10% which seems to be in accordance with current literature [10,13]. A preoperative lung infection leads to adhesions and therefore increases the risk of bleeding and parenchymal injury.…”

Section: Discussionsupporting

confidence: 91%

Surgical outcome after thoracoscopic lung resections for congenital lung lesions in children

Musters

Beer

Schuppen

et al. 2023

Preprint

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“…In contrast, a single-center study has shown decreased mean operative time of 13.1 min with thoracoscopic resection, although the difference was not statistically significant. However, the chest tube stay and length of stay were significantly longer in patients with open thoracotomy [ 20 ]. The possible explanation for these results may be the individual differences in the patients’ lesions and the different proficiency of surgeons.…”

Section: Discussionmentioning

confidence: 99%

Previous pulmonary infection impacts thoracoscopic procedure outcomes in patients with congenital lung malformations: a retrospective cohort study

et al. 2023

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Background and objectives Patients with congenital lung malformations (CLMs) are at high risk for developing pulmonary infection. Nonetheless, prophylactic surgical excision of asymptomatic CLMs is controversial and often delayed to symptoms occurring out of concern for potential operative risks. This study aims to evaluate the impact of previous pulmonary infection on the outcome of thoracoscopic procedures in CLMs patients. Methods This was a retrospective cohort study of CLMs patients who received an elective operation at a tertiary care center from 2015 to 2019. Patients were divided into pulmonary infection (PI) or non-infection of pulmonary (NPI) groups according to the history of pulmonary infection. Propensity score matching was used to minimize the bias between groups. The primary outcome was conversion to thoracotomy. Postoperative outcomes were compared between patients with and without PI. Results We identified 464 patients, of whom 101 had a history of PI. Propensity score matching yielded a well-balanced cohort of 174 patients. PI was associated with higher conversion to thoracotomy (adjusted odds ratio = 8.7, 95% confidence interval, CI, 1.1–71.2, p = 0.039), blood loss (p = 0.044), and longer operative time (p < 0.001), chest tube placement time (p < 0.001), length of stay (p < 0.001), and postsurgical length of stay (p < 0.001). Conclusions Elective operation in CLMs patients with a history of PI was associated with an increased risk of conversion to thoracotomy, operative time, blood loss, chest tube placement time, length of stay, and postsurgical length of stay. Elective thoracoscopic procedures in asymptomatic CLMs patients are safe and effective, and earlier surgical intervention may be warranted.

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“…Two studies added important outcomes data to the existing literature on management of congenital lung malformations. Ganarin et al 86 reported a retrospective analysis of 106 children who underwent surgical intervention for CLM between 1991 and 2020 at a single center, comparing the video‐assisted thoracoscopic (VATS) approach to thoracotomy. Procedures included sequestrectomy, atypical resection, cystectomy, and lobectomy.…”

Section: Congenital Airway and Lung Anomaliesmentioning

confidence: 99%

Pediatric pulmonology 2021 year in review: Rare and diffuse lung disease

Popler

Vece

Liptzin

et al. 2022

Pediatric Pulmonology

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The field of rare and diffuse pediatric lung disease is experiencing rapid progress as diagnostic and therapeutic options continue to expand. In this annual review, we discuss manuscripts published in Pediatric Pulmonology in 2021 in (1) children's interstitial and diffuse lung disease, (2) congenital airway and lung malformations, and (3) noncystic fibrosis bronchiectasis including primary ciliary dyskinesia. These include case reports, descriptive cohorts, trials of therapies, animal model studies, and review articles.The results are put into the context of other literature in the field. Each furthers the field in important ways, while also highlighting the continued need for further studies.

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Thoracoscopy versus thoracotomy for congenital lung malformations treatment: A single center experience

Cited by 12 publications

References 14 publications

Surgical outcome after thoracoscopic lung resections for congenital lung lesions in children

Surgical outcome after thoracoscopic lung resections for congenital lung lesions in children

Previous pulmonary infection impacts thoracoscopic procedure outcomes in patients with congenital lung malformations: a retrospective cohort study

Pediatric pulmonology 2021 year in review: Rare and diffuse lung disease

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