Abstract
PurposeThe purpose of this study is to evaluate the potential advantages of thoracoscopic versus open resection for symptomatic congenital pulmonary airway malformation (CPAM) in neonates.MethodsA retrospective review of the medical records of neonates (age ≤ 28 days) who underwent surgery for symptomatic CPAM from 2010 to 2020.ResultsOf the 24 patients, 14 patients underwent thoracoscopic resection and 10 patients underwent open resection. 4 patients with CPAM located in the upper or middle lobes underwent lobectomy, and 20 underwent lung-preserving wedge resection in the lower lobe. Between the two groups, there were no statistically significant differences in related preoperative variables, including gestational age at birth, body weight, head circumference, lesion size, cystic adenomatoid malformation volume ratio (CVR), and age at operation (P > .05). The differences in intraoperative variables were statistically significant. The length of the surgical incision was significantly shorter in thoracoscopic resection group than in open resection group (1.4 cm [1.3–1.8] vs. 6.0 cm [5.0–8.0], P = .000), along with significantly less operative blood loss (3 ml [1–6] vs. 5 ml [2–10], P = .030) but significantly longer operation time (159 min [100–220] vs. 110 min [70–170], P = .003). Regarding postoperative variables, ventilator days, duration of chest tube use and length of hospital stay were not statistically significant (P > .05).ConclusionBoth thoracoscopic and open resection for symptomatic CPAM achieve good clinical outcomes, even in neonates. Thoracoscopic resection has minimal aesthetic effects and does not increase the risk of surgical or postoperative complications. Lung-preserving resection may be feasible for neonatal CPAM surgery.
Highlights
Congenital pulmonary airway malformation (CPAM) is a foetal lung malformation characterized by benign malignancies or dysplastic lung tumours with excessive growth of terminal bronchioles and a decrease in the number of alveoli [1]
Whether asymptomatic CPAM requires surgery during the neonatal period is still controversial, but it is clear that surgery is the accepted standard of care for all symptomatic CPAMs, even in neonates [4, 5]
The study design was a retrospective review of the data from 24 symptomatic neonates with CPAM who underwent thoracoscopic or open resection at the Foshan Women and Children Hospital Affiliated to Southern Medical University, from April 2010 to April 2020
Summary
Congenital pulmonary airway malformation (CPAM) is a foetal lung malformation characterized by benign malignancies or dysplastic lung tumours with excessive growth of terminal bronchioles and a decrease in the number of alveoli [1]. The reported incidence of CPAM is 1:11,000 to 1:35,000 [2]. Whether asymptomatic CPAM requires surgery during the neonatal period is still controversial, but it is clear that surgery is the accepted standard of care for all symptomatic CPAMs, even in neonates [4, 5]. We carried out surgical treatment for symptomatic CPAM patients after the above symptoms had adequately subsided. CPAM can be treated with open or thoracoscopic resection. Few reports have compared the outcomes of the two surgical methods for the treatment of CPAM in neonates. The purpose of this study is to compare the preoperative, intraoperative, and postoperative variables of the two surgical procedures and to evaluate the potential advantages of thoracoscopic versus open resection for symptomatic CPAM in neonates
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