Is thoracoscopic lung-sparing surgery in treatment of congenital pulmonary airway malformation feasible?

Abstract

Purpose Lung-sparing strategies such as segmentectomy or atypical resection have been advocated for small congenital pulmonary airway malformation (CPAM), even by thoracoscopy. The aims of our study were to evaluate surgical and clinical outcome of patients undergoing lung-sparing surgery and to determine whether thoracoscopy is superior to thoracotomy. Methods We conducted a retrospective review of patients who underwent lung-sparing resection for CPAM from 2004 to 2018. Demographic data, presenting symptoms, size and location of the CPAM, operative and post-operative data were collected and analyzed according to surgical technique (thoracoscopy-TS, vs thoracotomy-TO). Data were compared using Fisher's exact test for qualitative values and Mann-Whitney test for quantitative values. P values less than 0.05 were considered as statistically significant. Results 167 lung-sparing surgery procedures were performed (segmentectomy n = 21 or atypical resection n = 146). 67 procedures were completed in TS. All histological examination revealed negative margins for residual CPAM. Patients in the TS group were older and presented a higher weight compared to the TO group. TS was associated with shorter duration of pleural drainage and shorter hospital stay. Rate of conversion was 35% (n = 29). Location of CPAM in the lower lobe and CPAM size greater than 5 cm were predictor factors of conversion from TS to TO. Conclusion Lung-sparing surgery for CPAM is a safe and feasible technique in pediatric patients. TS results in reduced postoperative morbidity compared to TO and should be proposed as first surgical approach for selected patients.

Is thoracoscopy superior to thoracotomy in the treatment of congenital lung malformations? An updated meta-analysis

“…Sensitivity analyses were used to explore the sources of heterogeneity in our study. The sensitivity analysis of operative times suggested a significant reduction in heterogeneity when we removed the studies of Zhang et al and Lima et al in turn, 31 , 32 and the pooled estimate remained statistically significant, which indicated a confirmed and robust result. In these two studies, the operative time for VATS was significantly shorter than that of thoracotomy.…”

“…I 2 reduced to 72% when we removed the studies of Zhang et al and Lima et al in turn. 31 , 32 This did not appreciably change the direction and magnitude of the pooled estimates (SMD, 0.65; 95% CI, 0.32–0.98; p = 0.0001).…”

“…After screening for duplicates and relevance in titles and abstracts, only 109 studies were available for the full-text evaluation for eligibility; 69 studies were excluded after full-text evaluation. Eventually, this review was based on 40 NRCTs, 11 – 50 which encompassed 23 two-arm case-controlled studies, 11 – 33 and 17 single-arm case series. 34 …”

“…A total of 22 studies compared the complications after surgery of both procedures. 11 – 31 , 33 Air leaks and chest infection were the most common complications after surgery. Pectus excavutum and scoliosis, which were the long-term complications with the use of thoracotomy, were reported in only one study.…”

“…A total of 17 studies compared the operative time of both surgical approaches. 11 , 12 , 15 , 17 , 19 , 20 , 22 – 27 , 29 – 33 However, in one study, Laje et al incorrectly reported the operative time data. 24 Therefore, this meta-analysis included the remaining 16 studies.…”