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Morbidity after thoracoscopic resection of congenital pulmonary airway malformations (CPAM): single center experience over a decade

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Abstract

Purpose

Video-assisted thoracoscopic (VATS) resection of CPAM in children is an established, albeit controversial strategy for its management. We report a 10-year single center experience.

Methods

All children underwent VATS (2008–2017) and their current status was reviewed. Patients were grouped: ‘symptomatic-P’ (if parents reported recurrent lower respiratory tract infections etc.) or ‘symptomatic-S’ (neonates presenting with respiratory distress/difficulty) or ‘asymptomatic’.

Results

73 children, aged 10 m (4d–14yrs) underwent VATS; a neonate as an emergency (‘symptomatic-S’) and all others electively. The lesion was unilateral in all but one case. Histologically none were malignant. Of the elective 72 cases, 7 (10%) required conversion to open thoracotomy. Twenty (27.7%) were ‘symptomatic-P’ and the duration of surgery when compared to ‘asymptomatic’ children was longer 269 (range 129–689) versus 178 (range 69–575) minutes (P = 0.01). Post operatively, 8 children (11%) had a grade III/IV (Clavien–Dindo) complication; persistent air leak/pneumothorax (n = 5), chylothorax (n = 1), pleural effusion (n = 1) and seizure/middle cerebral artery thrombosis (n = 1). There was no mortality. Twenty-four children (33.3%) were reported ‘symptomatic-P’ post-surgery after a median follow up of 2.18 years. The surgical intervention had no impact on ‘symptomatic-P’ status (P = 0.46).

Conclusion

The risks of surgery may outweigh benefit in asymptomatic children.

ClinicalTrials.gov Identifier

NCT04449614.

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Acknowledgement

HK was an intercalated B Sc medical student supported by King’s College, London. Authors are grateful to Atul Gupta respiratory physician for his contributions.

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Authors and Affiliations

  1. Royal Surrey County Hospital, Guildford, GU2 7XX, UK

    Hadiya Khan

  2. Department of Anesthetics, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK

    Meera Kurup, Sanjay Saikia, Malcolm Mathew, Asme Sheikh & Chulananda D. A. Goonasekera

  3. Consultant Paediatric Surgeon, Royal London Hospital, London, E11FR, UK

    Ashish Desai

Authors
  1. Hadiya Khan
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  2. Meera Kurup
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  3. Sanjay Saikia
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  4. Ashish Desai
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  5. Malcolm Mathew
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  7. Chulananda D. A. Goonasekera
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Contributions

H.K. contributed for data collection, data analysis, manuscript preparation, figures, tables and statistics, revision. M.K., M.M., S.S., A.D., and A.S. contributed to data interpretation, critical analysis, and discussion. C.G. was involved in study design, obtaining institution approval, data analysis, manuscript preparation, figures, tables, and statistics.

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Correspondence to Chulananda D. A. Goonasekera.

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Khan, H., Kurup, M., Saikia, S. et al. Morbidity after thoracoscopic resection of congenital pulmonary airway malformations (CPAM): single center experience over a decade. Pediatr Surg Int 37, 549–554 (2021). https://doi.org/10.1007/s00383-020-04801-1

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  • DOI: https://doi.org/10.1007/s00383-020-04801-1

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