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

86 Citations (Scopus)

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

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Congenital Cystic Adenomatoid Malformation of Lung
Confidence Intervals
Thoracoscopy
Length of Stay
Hospital Costs
Thoracotomy
Operative Time
Pneumonia
Thoracostomy
San Francisco
Odds Ratio
Incidence

Keywords

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

ASJC Scopus subject areas

  • Surgery

Cite this

Thoracoscopic versus open resection for congenital cystic adenomatoid malformations of the lung. / Vu, Lan T.; Farmer, Diana L; Nobuhara, Kerilyn K.; Miniati, Doug; Lee, Hanmin.

In: Journal of Pediatric Surgery, Vol. 43, No. 1, 01.2008, p. 35-39.

Research output: Contribution to journalArticle

Vu, Lan T. ; Farmer, Diana L ; Nobuhara, Kerilyn K. ; Miniati, Doug ; Lee, Hanmin. / Thoracoscopic versus open resection for congenital cystic adenomatoid malformations of the lung. In: Journal of Pediatric Surgery. 2008 ; Vol. 43, No. 1. pp. 35-39.
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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.",
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AU - Lee, Hanmin

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N2 - 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.

AB - 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.

KW - Congenital cystic adenomatoid malformation

KW - Congenital lung cysts

KW - Operative conversion

KW - Thoracoscopic resection

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