Medium-Term Pulmonary Function Test After Thoracoscopic Lobectomy and Segmentectomy for Congenital Lung Malformation: A Comparative Study With Normal Control.

Jin-Xi Huang,Hua Cao,Jun-Jie Hong,Qiang Chen,Song-Ming Hong

doi:10.3389/fped.2021.755328

Abstract

Purpose: This study aimed to compare the outcomes and pulmonary function test (PFT) of thoracoscopic segmentectomy and lobectomy in infants with congenital lung malformation and study the result of PFT on a medium-term basis.Methods: The clinical data of 19 infants with congenital lung malformation who underwent thoracoscopic surgery in our hospital from January 2018 to March 2019 were retrospectively studied; these infants were paired with another 19 infants who underwent thoracoscopic lobectomy during the same period using propensity score matching. Age-matched healthy individuals with similar body sizes were recruited for PFT as the control group. Patient characteristics, postoperative PFT, and outcomes were extracted for statistical analysis.Results: The average length of hospital stay did not significantly differ between segmentectomy and lobectomy groups. The segmentectomy group had more chest tube drainage than the lobectomy group. PFT 1 month after the operation showed that the tidal volume of the lobectomy group was lower than that of the segmentectomy group. Time to peak expiratory flow/time of expiration and peak flow/terminal airway velocity (V25%) indicated small airway dysfunction in the lobectomy group, and no obvious abnormalities were found in “time of inspiratory/time of expiration” in either group. Reexamination of pulmonary function 2 years after the operation showed that the small airway function of the segmentectomy group returned to normal, and no significant difference in pulmonary function was noted among the three groups.Conclusion: The short-term pulmonary function recovery was better after segmentectomy than after lobectomy. Patients who underwent thoracoscopic lobectomy and segmentectomy have normal lung function 2 years after the operation.

Highlights

Congenital lung malformation (CLM) is an uncommon pathology that involves the proliferation of terminal respiratory bronchioles at the expense of alveoli, leading to cysts of various sizes
No significant abnormalities were observed in the large airway function (TI/TE) of the two groups (0.8280 ± 0.105 in the segmentectomy group and 0.8170 ± 0.150 in the lobectomy group)
Two years after the operation, pulmonary function test (PFT) showed that VT was improved in the lobectomy group

Summary

Introduction

Congenital lung malformation (CLM) is an uncommon pathology that involves the proliferation of terminal respiratory bronchioles at the expense of alveoli, leading to cysts of various sizes. Wong [5] suggested that asymptomatic CLM patients would later develop symptoms and that early surgery might be beneficial to avoid complications. A radionuclide imaging study of long-term lung function in children undergoing lobectomy by Komori [7] found that the optimal age of surgery for CLM appears to be younger than 1 year to allow sufficient time for lung regrowth. Our center reported thoracoscopic lobectomy for a 4-day-old neonate with a large congenital pulmonary airway malformation [11]. Thoracoscopic surgery has become a conventional technique for the treatment of CLM [12], there are few reports on segmentectomy and the clinical comparison of lobectomy and segmentectomy for CLM. We compared the outcomes and mid-term follow-up of thoracoscopic segmentectomy and lobectomy for infants and evaluated the pulmonary function of CLM patients after thoracoscopic surgery on a medium-term basis

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