Segmental resection for the treatment of congenital pulmonary malformations

Bagrodia, Naina; Cassel, S Florence; Liao, Junlin; Pitcher, Graeme; Shilyansky, Joel

doi:10.1016/j.jpedsurg.2014.01.021

Cited by 39 publications

(32 citation statements)

References 22 publications

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“…In conclusion: (I) Without large series with prolonged follow-up, there is currently no argument for proposing embolization as the only curative treatment of an adult ILS, especially in the case of a large systemic artery and/or extensive parenchymal lesions; (II) If surgical resection is retained, there is no evidence to suggest that a lobectomy is preferable to sublobar resection, unless the sequestration involves almost all of a lobe; (III) Since perioperative morbidity of sublobar resection is reduced when performed by thoracoscopy rather than open chest surgery (15,16), we conclude, as other authors (8,9) that ILS can be safely treated by anatomical segmentectomies that should be performed, whenever possible, without opening the chest.…”

supporting

confidence: 64%

“…Pediatric surgeons who are aware of the importance of sublobar pulmonary resection, not only to spare respiratory function but also to allow for the most normal development of the thoracic cage which avoids scoliosis, have proposed performing segmentectomies (8,9), or even wedge resections (9,10). Bagrodia et al (8) did not record more recurrence after segmentectomy than after lobectomy in a large comparative series of surgical treatment of pulmonary malformations, including a majority of sequestrations. Fascetti-Leon et al have performed 54 sublobar resections (segmentectomies or wedge resection) for congenital pulmonary malformations and conclude that it is appropriate when the lesions are peripheral and limited in size (9).…”

Section: Discussionmentioning

confidence: 99%

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Adult pulmonary intralobar sequestrations: changes in the surgical management

Traibi¹,

Seguin‐Givelet²,

Brian³

et al. 2018

J. Vis. Surg.

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Background: Until now, the traditional procedure to treat intralobar pulmonary sequestration (ILS) in adults has been a lobectomy performed by open chest surgery. We have reviewed our data to determine whether the surgical management of these lesions has evolved over the last years. Methods:We retrospectively reviewed the records of patients who were operated on for an ILS by either posterolateral thoracotomy (PLT group), or by thoracoscopy (TS group) between 2000 and 2016.Results: Eighteen patients were operated on for a ILS during this period. Before 2011, all resections were performed by thoracotomy (n=6) and after 2011 the approach was either a thoracotomy (n=5) or a thoracoscopy (n=7). There was one conversion because of dense pleural adhesions and this patient was integrated in the PLT group for further analysis. ILS presented more frequently on the left side (n=12, 66.7%) than on the right one (n=6, 33.3%) and exclusively in the lower lobes. All the PLT group patients underwent a lobectomy. In the TS group, five patients underwent a sublobar resection (2 segmentectomies S9+10, 1 basilar segmentectomy and 2 atypical resections). There was no mortality. In the PLT group, 5 patients (45%) had complications versus one patient (14%) in the TS group. The mean hospital stay was 7.4 days in the PLT group versus 5.4 days in the TS group.Conclusions: These data confirm that ILS can be safely treated by a sublobar resection that should be performed, whenever possible, without opening the chest. descending thoracic abdominal aorta or even the celiac trunk, with normal venous drainage into the pulmonary veins. They are usually located in the basal segments of the lower lobes. They are covered with a normal visceral pleura shared with the adjacent healthy pulmonary parenchyma. ILS are often detected in adulthood after pulmonary infections and/or haemoptysis, and more rarely, after cardiac insufficiency by venous return overload (2). They are sometimes discovered accidentally or confused with another condition. Until recently, the treatment of ILS was exclusively surgical and was based on the interruption of the systemic artery associated with lobectomy by open chest surgery. Other surgical or non-surgical treatments have recently been proposed, aiming to be less invasive and to spare the pulmonary parenchyma. The aim of this work is to determine if the surgical management of these lesions has evolved over the last years.Methods B e t w e e n J a n u a r y 2 0 0 0 a n d D e c e m b e r 2 0 1 6 , w e retrospectively reviewed the records of patients who underwent surgery for pulmonary sequestration in our department. Clinical and demographic data including patients age, sex, preoperative symptoms, type of surgery, type of resection and postoperative course were analyzed ( Table 1). The approach was a posterolateral thoracotomy (PLT group) or an exclusive thoracoscopy (TS group) according to a standardized technique previously described in details (3). Briefly, the procedure was performed under general anesthesia with spli...

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supporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Adult pulmonary intralobar sequestrations: changes in the surgical management

Traibi¹,

Seguin‐Givelet²,

Brian³

et al. 2018

J. Vis. Surg.

View full text Add to dashboard Cite

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“…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.…”

Section: Surgery and Outcomementioning

confidence: 99%

Congenital lung lesions: Postnatal management and outcome

Parikh

Rasiah

2015

Seminars in Pediatric Surgery

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“…In uniportal VATS group, one patient developed subglottic stenosis, which was related to urgent intubation in ICU rather than surgery. The only true surgical complication was delayed pneumothorax for a CPAM 15-year-old girl and the reported rate of pneumothorax after lung-sparing resection is approximately 10% [35,36]. Blood loss was severe in the multiportal VATS group, and the difficulty of checking and lacking space was the main contributor to the result.…”

Section: Discussionmentioning

confidence: 98%

Uniportal Thoracoscopic Lobectomy for Congenital Lung Malformations in Children

Chou¹,

Huang²,

Yeh³

et al. 2018

J Surg

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Introduction: Single-incision paediatric endosurgery is gaining popularity, especially for abdominal operations. However, few reports in the literature support the feasibility of uniportal thoracoscopic surgery for congenital lung malformations in paediatric patients. This paper presented the initial experience with uniportal thoracoscopic surgery and compared the surgical outcomes with multiport Video-Assisted Thoracoscopic Surgery (VATS) and traditional thoracotomy. Materials and Methods: From January 2009 to January 2018, a retrospective review of all patients (less than 18 years old) who underwent surgery for congenital lung malformations at our institution was performed. General data, operative data, anaesthesia parameters and surgical outcomes were collected. Results were analysed with one-way ANOVA and chi-square tests for continuous and categorical data. Results: Twenty-one patients with congenital lung malformations underwent surgery at our institution. The number of patients enrolled in thoracotomy, multiportal VATS and uniportal VATS groups was 8, 6 and 7, respectively. No difference in age, body weight, post-operative stay and drainage period was observed among the groups. A considerably high conversion rate (3/6, 50%) was observed in the multiportal VATS group. After the introduction of endobronchial blocker for one lung ventilation, all multi-portal and uniportal VATS procedures could be performed safely without residual lesion or mortality. Conclusions: VATS is feasible in the paediatric population, and it needs experienced surgical skills and unique anaesthetic requirements. For small infants with congenital lung malformations, uniportal VATS with endobronchial blocker is preferred.

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Segmental resection for the treatment of congenital pulmonary malformations

Cited by 39 publications

References 22 publications

Adult pulmonary intralobar sequestrations: changes in the surgical management

Adult pulmonary intralobar sequestrations: changes in the surgical management

Congenital lung lesions: Postnatal management and outcome

Uniportal Thoracoscopic Lobectomy for Congenital Lung Malformations in Children

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