Lack of consensus among Canadian pediatric surgeons regarding the management of congenital cystic adenomatoid malformation of the lung

Abstract

Purpose: Review of the literature suggests that there is lack of consensus regarding the management of antenatally diagnosed congenital cystic adenomatoid malformation of the lung (CCAM) that is asymptomatic at birth. This study aims to describe the variability among Canadian pediatric surgeons in how this pathologic finding is managed.

Methods: Surveys were sent to all practicing Canadian members of Canadian Association of Pediatric Surgeons. Responders were asked to state whether they recommend resection or nonoperative management and to describe the follow-up imaging type and frequency used.

Results: A 69% response rate was obtained. There was no consistency regarding the imaging modality used to detect asymptomatic CCAM. Sixty-seven percent of responders recommend resection of persistent but asymptomatic CCAM; there was neither consensus with regard to age at which resection is performed (2-18 months) nor technical considerations at resection (61% open, 83% lobectomy). Among the responders who do not recommend resection, the frequency of follow-up was variable (every 3 months to every year), as were the imaging modality used and the length of follow-up (3 years to indefinitely); 80% of neonates in whom nonoperative management was recommended initially ultimately underwent resection.

Conclusions: Lack of consensus among Canadian pediatric surgeons, and even within institutions, regarding the management of antenatally diagnosed CCAM in the asymptomatic neonate, is demonstrated. This clearly highlights the need for prospective studies.