Thoracoscopic versus open resection for congenital cystic adenomatoid malformations of the lung

Lan T. Vu, Diana L Farmer, Kerilyn K. Nobuhara, Doug Miniati, Hanmin Lee

Research output: Contribution to journalArticle

90 Scopus citations

Abstract

Purpose: This study evaluated the potential advantages of thoracoscopy compared to thoracotomy for resection of congenital cystic adenomatoid malformations (CCAM). Methods: We conducted a retrospective chart review of consecutive cases of CCAM resection at University of California San Francisco Children's Hospital from January 1996 to December 2006. Results: Thirty-six cases of postnatal CCAM resections were done over the past 10 years; 12 patients had thoracoscopic resections, whereas 24 patients had open resections. Patients in the thoracoscopic group had significantly longer operative time (mean difference of 61.3 minutes; 95% confidence interval [CI], 30.5-92.1) but shorter postoperative hospital stay (mean difference of 5.7 days; 95% CI, 0.9-10.4) and duration of tube thoracostomy (mean difference of 2.6 days; 95% CI, 0.7-4.5) and lower odds of postoperative complications (odds ratio of 9.0 × 10-4; 95% CI, 8.0 × 10-6-0.1). In the subgroup analysis of only asymptomatic patients, the thoracoscopy group still had a significantly shorter hospital stay (mean difference of 2.8 days; 95% CI, 0.7-4.8). There was also a pattern for reduced complications in the thoracoscopy group (OR, 0.13; 95% CI, 0.02-1.0; P = .05). The average hospital costs were similar in both groups. With a conversion rate of 33% (6/18), patients with a history of preoperative respiratory symptoms had a higher incidence of conversion than those who were asymptomatic (66.7% vs 0%, P = .005). These four patients had a history of pneumonia. Conclusion: Minimally invasive resection of CCAM results in longer operative time but shorter hospital stay, potentially reduced complications, and no additional hospital costs. Thoracoscopic lobectomy in patients with a history of pneumonia is challenging and a risk factor for conversion to thoracotomy.

Original languageEnglish (US)
Pages (from-to)35-39
Number of pages5
JournalJournal of Pediatric Surgery
Volume43
Issue number1
DOIs
StatePublished - Jan 2008

Keywords

  • Congenital cystic adenomatoid malformation
  • Congenital lung cysts
  • Operative conversion
  • Thoracoscopic resection

ASJC Scopus subject areas

  • Surgery

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