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Non-operative management of extralobar pulmonary sequestration: a safe alternative to resection?

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Abstract

Purpose

This retrospective cohort study compares the natural history of patients with extralobar sequestrations (ELS) who do not undergo intervention with those who undergo resection to assess the safety of non-operative management.

Methods

126 patients with pulmonary sequestrations or congenital pulmonary airway malformations born between 1999 and 2016 were identified. 49 patients had ELS on postnatal imaging, but two were excluded for associated congenital diaphragmatic hernia. Demographic and clinical data were retrospectively reviewed, with phone follow-up for non-operative patients with no records for > 1 year. Statistical analysis was by Fisher’s exact test or Wilcoxon signed-rank test (two-tailed p < 0.05).

Results

40% (19/47) were managed non-operatively and 60% (28/47) underwent resection. Non-operative patients were less likely to have an intrathoracic ELS: 47% (9/19) vs. 75% (21/28), p = 0.07. No symptoms were attributable directly to the ELS. Non-operative patients had median follow-up 3.2 years, during which time 88% (15/17) of ELS decreased in size on serial imaging. For patients who underwent resection, there was 100% concordance between imaging and intraoperative findings. There was no evidence of inflammation, infection or malignancy on final pathology, though 57% (16/28) of resected lesions had foci of non-aerated cysts.

Conclusions

Although further longitudinal study is required, this study supports the safety of non-operative ELS management.

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Acknowledgements

H.F.S. was supported by the Joshua Ryan Rappaport Fellowship of the Department of Surgery at Boston Children’s Hospital.

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Author notes

  1. Victoria K. Robson and Hester F. Shieh contributed equally to this work.

Authors and Affiliations

  1. Department of Medicine and Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, 02115, USA

    Victoria K. Robson

  2. Department of Surgery, Boston Children’s Hospital and Harvard Medical School, 300 Longwood Avenue, Fegan 3rd Floor, Boston, MA, 02115, USA

    Hester F. Shieh, Jay M. Wilson & Terry L. Buchmiller

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  1. Victoria K. Robson
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Contributions

Study conception and design: VKR, HFS, JMW, TLB. Data acquisition: VKR, HFS, TLB. Analysis and data interpretation: VKR, HFS, JMW, TLB. Drafting of the manuscript: VKR, HFS. Critical revision: VKR, HFS, JMW, TLB

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Correspondence to Terry L. Buchmiller.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Robson, V.K., Shieh, H.F., Wilson, J.M. et al. Non-operative management of extralobar pulmonary sequestration: a safe alternative to resection?. Pediatr Surg Int 36, 325–331 (2020). https://doi.org/10.1007/s00383-019-04590-2

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