Asymptomatic Congenital Lung Malformations: Timing of Resection Does Not Affect Adverse Surgical Outcomes.

Vincent Duron,Ariela Zenilman,Weijia Fan,Maggie Schmaedick,Juliana Castrillon,Cornelia Griggs,Jennifer Defazio,Jessica C Price,Emaad Iqbal,Steven Rothenberg,Matthew Vivero

doi:10.3389/fped.2020.00035

Abstract

Background: Optimal timing for resection of asymptomatic congenital lung malformations (CLMs) remains controversial. The aim of this study is to define optimal timing for surgical intervention of patients with CLMs and define clinical variables that affect surgical outcomes.Methods: An IRB-approved retrospective analysis was conducted for patients undergoing surgery for CLMs between 2012 and 2017. Subjects were divided into cohorts based on timing of operative intervention. “Early intervention” was defined as surgery within 4 months of birth; “intermediate intervention”—between 4 and 6 months; and “late intervention”−6–12 months. Surgical outcomes including intraoperative estimated blood loss (EBL), surgical time, post-operative pneumothorax, length of time chest tube stayed in, and hospital length of stay were compared among the three groups using Fisher's exact test or Chi-squared test for categorical variables and one-way analysis of variance test for continuous variables.Results: We analyzed 63 patients who underwent surgery for CLM. There were no significant differences in baseline characteristics. Timing of surgery did not significantly correlate with post-operative outcomes. Specifically, there was no difference in operative time, EBL, post-operative pneumothorax, or length of hospital stay among the early, intermediate, and late intervention groups. Even after controlling for cyst-volume ratio (CVR), timing of surgery still did not affect post-operative outcomes.Conclusions: Surgical outcomes for resection of CLMs are not significantly affected by timing of surgery. We advocate for early intervention to decrease the incidence of associated complications that can occur with later intervention.

Highlights

Congenital pulmonary airway malformation (CPAM) are hamartomatous masses of the airway and lungs with cystic and adenomatous features believed to result from abnormal branching development of the lung in utero
The surgeries were performed in an academic center with pediatric surgery fellows
EI, Early intervention group; intermediate intervention (IMI), Intermediate intervention group; late intervention (LI), Late intervention group; N-unidentified, Number of patients with no data recorded for variable; LLL, Left lower lobe; LUL, Left upper lobe; RLL, Right lower lobe; RML, Right middle lobe; RUL, Right upper lobe

Summary

Introduction

Congenital pulmonary airway malformation (CPAM) are hamartomatous masses of the airway and lungs with cystic and adenomatous features believed to result from abnormal branching development of the lung in utero. Many surgeons operate on these lesions during infancy to prevent infection, malignant transformation and to allow compensatory lung growth [3,4,5,6]. Intervention decreases the risk of respiratory infections and the risk of malignant transformation It may allow more time for compensatory lung growth, which is thought to continue during infancy [8, 9]. The purpose of this study is to [1] define optimal timing for surgical intervention of patients with CLMs and [2] define clinical variables that affect surgical outcomes. The aim of this study is to define optimal timing for surgical intervention of patients with CLMs and define clinical variables that affect surgical outcomes

Objectives

Methods

Results

Conclusion