Early vs late resection of asymptomatic congenital lung malformations

Abstract

Purpose: To examine postsurgical outcomes of a consecutive series of children treated with elective operations for congenital lung malformations (CLM).

Methods: A retrospective review was performed on a prospectively collected dataset of all fetuses evaluated for a CLM between July 2001 and June 2016. Prenatal findings, operative treatment and postnatal outcomes were collected. Children having elective operations were divided in two groups based on age at time of surgery.

Results: Of 220 fetuses, 143 had operations and follow-up at our center. Six had open fetal lobectomy, 17 had EXIT-to-resection, 16 infants had urgent resection for symptoms and 110 with asymptomatic lesions had elective resection. Of these 110, the median fetal maximum CVR was 0.8 [range 0.1-2.2], and median age at operation was 4 (1.5-60) months (58% had resection at ≤4 months). Overall complication rate, including air-leak and pleural effusion, was 15%. When comparing those having resection at ≤4 months to those >4 months, there were no significant differences in complication rates or length of stay. Operative time was shorter for patients with early resection (154 ± 59 vs 181 ± 89, p = 0.05). No infant having resection at ≤4 months was readmitted. Overall, children survived with good recovery.

Conclusion: Early elective resection of congenital lung malformations prior to 4 months of age is feasible and not associated with increased operative risk.

Type of study: Restropective study.

Level of evidence: Level III.

Keywords: CLM; CPAM; Congenital lung lesion; Elective resection; Lung lesions.