Pulmonary function after early vs late lobectomy during childhood: a preliminary study

doi:10.1016/j.jpedsurg.2009.01.021

Journal of Pediatric Surgery

Volume 44, Issue 5, May 2009, Pages 893-895

https://doi.org/10.1016/j.jpedsurg.2009.01.021 Get rights and content

Abstract

Background

One proposed reason for the early resection of asymptomatic congenital cystic adenomatoid malformations is the theoretical benefit of optimizing compensatory lung growth during infancy and early childhood. Our aim was to determine if early lobectomy is associated with better long-term pulmonary function than lobectomy later in childhood.

Methods

A retrospective chart review of children undergoing pulmonary lobectomy for benign disease from 1990 to 2006 was performed. Those having surgery before and after 2 years of age were compared. Forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV₁) were used as indicators of pulmonary growth, with FVC less than 80% predicted and FEV₁ less than 80% consistent with impaired pulmonary function.

Results

Of 115 patients identified, 14 had postoperative pulmonary function testing at a mean age of 10 years. Of these, 7 had lobectomy before and 7 had lobectomy after 2 years of age. There was no significant difference between groups in mean FVC (81.5 vs 83.3) or the number of children with FVC less than 80% predicted, nor was there a difference in mean FEV₁ (87.6 vs 82.9) or the number of children with FEV₁ less than 80%.

Conclusions

Age at the time of lobectomy did not influence FVC or FEV₁. These preliminary data suggest that early lobectomy does not confer an advantage to the child with respect to long-term pulmonary function. A prospective study is necessary to confirm or refute these findings in a larger group of children.

Section snippets

Methods

The medical records of all children operated on for benign pulmonary lesions between 1990 and 2006 at a single institution were reviewed. The following data were extracted from the files: number of patients, age, sex, age at operation, type of operation, complications, number of thoracoscopic resections, and pulmonary function tests. The threshold age of 2 years was chosen because most of the alveolar development occurs in the first 2 years of life [10]. In addition, most operations for the

Results

A total of 115 children underwent resection for a benign lung lesion between 1990 and 2006 (63 male and 52 female), with 6 patients having incomplete medical information. The mean age of all children at the time of the chart review was 10.4 years. Mean age at operation was 2.4 years. Eighty-two children were operated on before 2 years of age and 33 after 2 years of age. There were complications in 10 patients: 4 persistent pneumothorax, 2 postoperative pneumonia, 1 atelectasis, 1 respiratory

Discussion

In this study, 10% of the patients undergoing lobectomy for a benign lung lesion at The Hospital for Sick Children for a 17-year period underwent pulmonary function tests postoperatively. Half of the patients had surgery before 2 years of age and the other half after the age of 2 years. Although the sample size is small, we found no significant differences in the results of the pulmonary function tests between the 2 groups, suggesting that lobectomy during infancy does not provide a functional

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Citation Excerpt :
In any lobectomy, there is also a small but real potential for major operative and anesthetic complications (including massive hemorrhage and/or death) [40,41]. Finally, the long-term effectiveness of early operative management on reducing cancer risk, preventing respiratory sequelae, and improving pulmonary function has not been fully elucidated [42,43]. In this study, we attempted to address this debate by investigating clinical outcomes in a subset of asymptomatic CLM patients who were initially managed by serial observation.
The purpose of this study was to evaluate clinical outcomes in children with asymptomatic congenital lung malformations (CLM) who were initially managed nonoperatively.
An IRB-approved retrospective review was performed on all CLMs at a single tertiary care referral center (Jan 2006–Dec 2016, n = 140). Asymptomatic cases that did not undergo elective resection were evaluated for subsequent CLM-related complications based on clinical records and a telephone quality of life survey.
Out of 39 (27.9%) who were initially managed nonoperatively, 13 (33%) developed CLM-related symptoms and underwent surgical intervention at a median age of 6.8 years (range, 0.7–19.8 years). The most common indication for conversion to operative management was pneumonia (78%). Larger lesions, as measured by CT scan, were significantly associated with the need for subsequent surgical intervention (mean maximal diameter, 5.7 vs. 2.9 cm; p = 0.005). Based on survey data with a median follow up of 3.9 years (range, 0.2–13.2 years), 17% developed chronic pulmonary symptoms, including cough (11%) and asthma requiring bronchodilators (12%).
Although these data support nonoperative management as a viable alternative to surgical resection, at least one-third of CLM children eventually develop pneumonia or other pulmonary symptoms. Larger lesions are correlated with an increased risk for eventual surgical resection.
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Out of 85 patients who underwent lobectomy at a median age of 5 months, 50 met the inclusion criteria, and 28 patients were tested. More than 80% of patients had normal FEV₁ and FVC. The mean FEV₁, FVC, FEF_25–75% values were higher in the patients operated before reaching one year of age.
The long-term outcome after lobectomy was excellent for most patients, as they retained a normal long-term PF. Therefore, for asymptomatic patients, a surgical approach before one year of age to avoid complications such as malignancy and to ensure an optimal PF catch-up could be beneficial.
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: Presented at the 40th Annual CAPS Meeting, August 21-24, 2008, Toronto, Ontario, Canada.

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Pulmonary function after early vs late lobectomy during childhood: a preliminary study

Abstract

Background

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Am J Obstet Gynecol

Hum Pathol

J Pediatr Surg

J Pediatr Surg

Ann Thorac Surg

J Pediatr Surg

J Thorac Cardiovasc Surg