Is thoracoscopic lung-sparing surgery in treatment of congenital pulmonary airway malformation feasible?

Abstract

Lung-sparing strategies such as segmentectomy or atypical resection have been advocated for small congenital pulmonary airway malformation (CPAM), even by thoracoscopy. The aims of our study were to evaluate surgical and clinical outcome of patients undergoing lung-sparing surgery and to determine whether thoracoscopy is superior to thoracotomy. We conducted a retrospective review of patients who underwent lung-sparing resection for CPAM from 2004 to 2018. Demographic data, presenting symptoms, size and location of the CPAM, operative and post-operative data were collected and analyzed according to surgical technique (thoracoscopy—TS, vs thoracotomy—TO). Data were compared using Fisher’s exact test for qualitative values and Mann–Whitney test for quantitative values. P values less than 0.05 were considered as statistically significant. 167 lung-sparing surgery procedures were performed (segmentectomy n = 21 or atypical resection n = 146). 67 procedures were completed in TS. All histological examination revealed negative margins for residual CPAM. Patients in the TS group were older and presented a higher weight compared to the TO group. TS was associated with shorter duration of pleural drainage and shorter hospital stay. Rate of conversion was 35% (n = 29). Location of CPAM in the lower lobe and CPAM size greater than 5 cm were predictor factors of conversion from TS to TO. Lung-sparing surgery for CPAM is a safe and feasible technique in pediatric patients. TS results in reduced post-operative morbidity compared to TO and should be proposed as first surgical approach for selected patients.