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Pio L, Gentilino V, Macchini F, Scarpa AA, Lo Piccolo R, Conforti A, Ratta A, Guanà R, Molinaro F, Costanzo S, Riccipetitoni G, Lisi G, Midrio P, Tocchioni F, Cobellis G, Volpe A, Zolpi E, Morandi A, Ciardini E, Vella C, Grella MG, Sergio M, Guida E, Nanni L, Ceccanti S, Di Benedetto V, Cheli M, Garzi A, Nobili M, Gabriele V, Boroni G, Incerti F, Zampieri N, Cacciaguerra S, Ceccarelli PL, Escolino M, Briganti V, Gori D, Esposito C, Gamba P, Gennari F, Inserra A, Dall'Igna P, Romeo C, Bagolan P, Bleve C, Chiarenza F, Morini F, Pelizzo G, Torre M. Congenital lung malformations: a nationwide survey on management aspects by the Italian Society of Pediatric Surgery. Pediatr Surg Int 2024; 40:53. [PMID: 38340215 DOI: 10.1007/s00383-024-05635-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Over the years, congenital lung malformations (CLM) management remains a controversial topic in pediatric thoracic surgery. The Italian Society of Pediatric Surgery performed a national survey to study the current management variability among centers, trying to define national guidelines and a standardized approach of children with congenital lung malformations. METHODS Following a National Society approval, an electronic survey including 35 items on post-natal management was designed, focusing on surgical, anesthesiology, radiology and pneumology aspects. The survey was conducted contacting all pediatric surgical units performing thoracic surgery. RESULTS 39 pediatric surgery units (97.5%) participated in the study. 13 centers (33.3%) were classified as high-volume (Group A), while 26 centers (66.7%) were low volume (Group B). Variances in diagnostic imaging protocols were observed, with Group A performing fewer CT scans compared to Group B (p = 0.012). Surgical indications favored operative approaches for asymptomatic CLM and pulmonary sequestrations in both groups, while a wait-and-see approach was common for congenital lobar emphysema. Surgical timing for asymptomatic CLM differed significantly, with most high-volume centers operating on patients younger than 12 months (p = 0.02). Thoracoscopy was the preferred approach for asymptomatic CLM in most of centers, while postoperative long-term follow-up was not performed in most of the centers. CONCLUSION Thoracoscopic approach seems uniform in asymptomatic CLM patients and variable in symptomatic children. Lack of uniformity in surgical timing and preoperative imaging assessment has been identified as key areas to establish a common national pattern of care for CLM.
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Affiliation(s)
- Luca Pio
- Pediatric Thoracic and Airway Surgery, IRCCS Giannina Gaslini, Genoa, Italy.
- Department of Surgery, MS133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA.
| | - Valerio Gentilino
- Unit of Pediatric Surgery, Woman and Child Department, Filippo del Ponte Hospital-ASST Sette Laghi, Varese, Italy
| | | | | | - Roberto Lo Piccolo
- Department of Emergency, Critical Area and Pediatric Surgery, Meyer University Children's Hospital, University of Florence, Florence, Italy
| | - Andrea Conforti
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children Hospital-Research Institute, Rome, Italy
| | - Alberto Ratta
- Pediatric Surgery Unit, Infermi Hospital, Rimini, Italy
| | - Riccardo Guanà
- Department of Pediatric General Surgery, Regina Margherita Children's Hospital, Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza, Turin, Italy
| | - Francesco Molinaro
- Division of Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Sara Costanzo
- Pediatric Surgery Department, Vittore Buzzi" Children's Hospital, Milan, Italy
| | - Giovanna Riccipetitoni
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Pediatric Surgery Unit, Department of Maternal and Child Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gabriele Lisi
- Department of Pediatric Surgery "Spirito Santo", Hospital of Pescara "G. D'annunzio", University Chieti-Pescara, Pescara, Italy
| | - Paola Midrio
- Pediatric Surgery, Cà Foncello Hospital, Treviso, Italy
- Pediatric Surgery, University of Padua, Padua, Italy
| | - Francesca Tocchioni
- Department of Pediatric and Neonatal Surgery, Meyer Children's Hospital, Florence, Italy
| | - Giovannii Cobellis
- Unit of Pediatric Surgery, Salesi Children's Hospital, Marche Polytechnic University, Ancona, Italy
| | - Andrea Volpe
- Pediatric Surgery Unit, Women's and Children's Health Department, University Hospital of Padua, Padua, Italy
| | - Elisa Zolpi
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
| | - Anna Morandi
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Claudio Vella
- Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Maria Giovanna Grella
- Department of Pediatric Surgery, Santobono Pausilipon Children's Hospital, Naples, Italy
| | - Maria Sergio
- Policlinico Universitario di Palermo, Palermo, Italy
| | - Edoardo Guida
- Department of Pediatric Surgery, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Lorenzo Nanni
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Silvia Ceccanti
- Pediatric Surgery Unit, Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy
| | | | - Maurizio Cheli
- Department of Paediatric Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Alfredo Garzi
- Dipartimento di Chirurgia Pediatrica e Robotica, Università di Salerno, Salerno, Italy
| | - Maria Nobili
- Pediatric Surgery Unit, University of Foggia, Foggia, Italy
| | | | - Giovanni Boroni
- Department of Pediatric Surgery, Azienda Ospedaliera Spedali Civili, Brescia, Italy
| | - Filippo Incerti
- Department of Pediatric Surgery, Umberto Bosio Center for Digestive Diseases, The Children Hospital AO SS Antonio E Biagio E Cesare Arrigo, Alessandria, Italy
| | - Nicola Zampieri
- Woman and Child Hospital, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | | | | | - Maria Escolino
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Vito Briganti
- Department of Pediatric Surgery and Urology Unit, San Camillo Forlanini Hospital, Rome, Italy
| | - Davide Gori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126, Bologna, Italy
| | - Ciro Esposito
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery Unit, Women's and Children's Health Department, University Hospital of Padua, Padua, Italy
- Pediatric Surgery, Department of Women's and Children's Health, Padua University, Padua, Italy
| | - Fabrizio Gennari
- Department of Pediatric General Surgery, Regina Margherita Children's Hospital, Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza, Turin, Italy
| | - Alessandro Inserra
- General Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
- Department of Systems Medicine, University of Tor Vergata, Rome, Italy
| | - Patrizia Dall'Igna
- Department of Emergencies and Organ, Transplantation Azienda Ospedaliero-Universitaria Consorziale Ospedale Pediatrico Giovanni XXIII, Bari, Italy
- University of Bari, Bari, Italy
| | - Carmelo Romeo
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | - Pietro Bagolan
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children Hospital-Research Institute, Rome, Italy
- Department of Systems Medicine, University of Tor Vergata, Rome, Italy
| | - Cosimo Bleve
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
| | - Fabio Chiarenza
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
| | - Francesco Morini
- Department of Pediatric and Neonatal Surgery, Meyer Children's Hospital, Florence, Italy
| | - Gloria Pelizzo
- Pediatric Surgery Department, Vittore Buzzi" Children's Hospital, Milan, Italy
| | - Michele Torre
- Pediatric Thoracic and Airway Surgery, IRCCS Giannina Gaslini, Genoa, Italy
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Ichino M, Morandi A, Macchini F, Maestri F, Consonni D, Farolfi A, Ophorst M, Leva E. Congenital Lung Malformations: Pulmonary Function Assessment Before and After Surgery. J Pediatr Surg 2023; 58:2081-2087. [PMID: 37586902 DOI: 10.1016/j.jpedsurg.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 07/15/2023] [Accepted: 07/16/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND The management of asymptomatic congenital lung malformations (CLM) is debated, and pulmonary function of patients with CLM is seldom discussed. Short-term respiratory outcome in patients operated for CLM was assessed in order to better define surgical impact. METHODS A retrospective study on patients operated for CLM between 2012 and 2021 was performed. Respiratory function was assessed with tidal breath analysis (TBA) in spontaneous sleep within 2 years of life. Patients with comorbidities affecting pulmonary function were excluded. Three variables were studied: tPTEF/tE (time to peak tidal expiratory flow/total expiratory time), tV (tidal volume), RR (respiratory rate). Results were assessed as z-score (normal ±1.64) and expressed as median (range). Pre- and post-operative results were compared, as well as post-operative results of disease and surgery type subgroups. RESULTS Thirty-nine patients were included. Median pre- and post-operative tPTEF/tE were normal (pre: -0.32 (-2.12; +1.56); post: -0.18 (-1.62; +2.43)). Patients with extralobar sequestration had pre-operative high median RR, which improved after sequestrectomy (pre: +1.99 (-2.49; +7.43); post -0.22 (-3.01; +1.18)). All groups had reduced pre-operative median tV, which restored after surgery (pre: -2.15 (-9.75; +0.91); post: -0.35 (-6.65; +3.14)). Patients undergoing lobectomy and patients with intralobar sequestration showed greater improvement. Median post-operative TBA results were normal for all sub-groups except for reduced tV in patients operated with thoracotomy (-2.27 (-6.12; +5.26)). CONCLUSIONS Patients with clinically asymptomatic CLM can have pathologic pulmonary function tests, which improve after surgery. These results add to the elements in favor of an interventional approach. LEVEL OF EVIDENCE III, Treatment study.
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Affiliation(s)
- Martina Ichino
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy.
| | - Anna Morandi
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Francesco Macchini
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Francesca Maestri
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Andrea Farolfi
- Neonatal Intensive Care Unit (NICU), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Marijke Ophorst
- Neonatal Intensive Care Unit (NICU), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Ernesto Leva
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122, Milan, Italy
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Luo D, Cheng K, Yuan M, Xu C, He T, Jia R, Dai S, Liu C. Previous pulmonary infection impacts thoracoscopic procedure outcomes in patients with congenital lung malformations: a retrospective cohort study. Respir Res 2023; 24:115. [PMID: 37072849 PMCID: PMC10114450 DOI: 10.1186/s12931-023-02412-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 03/30/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Patients with congenital lung malformations (CLMs) are at high risk for developing pulmonary infection. Nonetheless, prophylactic surgical excision of asymptomatic CLMs is controversial and often delayed to symptoms occurring out of concern for potential operative risks. This study aims to evaluate the impact of previous pulmonary infection on the outcome of thoracoscopic procedures in CLMs patients. METHODS This was a retrospective cohort study of CLMs patients who received an elective operation at a tertiary care center from 2015 to 2019. Patients were divided into pulmonary infection (PI) or non-infection of pulmonary (NPI) groups according to the history of pulmonary infection. Propensity score matching was used to minimize the bias between groups. The primary outcome was conversion to thoracotomy. Postoperative outcomes were compared between patients with and without PI. RESULTS We identified 464 patients, of whom 101 had a history of PI. Propensity score matching yielded a well-balanced cohort of 174 patients. PI was associated with higher conversion to thoracotomy (adjusted odds ratio = 8.7, 95% confidence interval, CI, 1.1-71.2, p = 0.039), blood loss (p = 0.044), and longer operative time (p < 0.001), chest tube placement time (p < 0.001), length of stay (p < 0.001), and postsurgical length of stay (p < 0.001). CONCLUSIONS Elective operation in CLMs patients with a history of PI was associated with an increased risk of conversion to thoracotomy, operative time, blood loss, chest tube placement time, length of stay, and postsurgical length of stay. Elective thoracoscopic procedures in asymptomatic CLMs patients are safe and effective, and earlier surgical intervention may be warranted.
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Affiliation(s)
- Dengke Luo
- Department of Pediatric Surgery, West China Hospital of Sichuan University, No 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Kaisheng Cheng
- Department of Pediatric Surgery, West China Hospital of Sichuan University, No 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Miao Yuan
- Department of Pediatric Surgery, West China Hospital of Sichuan University, No 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Chang Xu
- Department of Pediatric Surgery, West China Hospital of Sichuan University, No 37, Guo Xue Xiang, Chengdu, 610041, China.
| | - Taozhen He
- Department of Pediatric Surgery, West China Hospital of Sichuan University, No 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Ru Jia
- Department of Pediatric Surgery, West China Hospital of Sichuan University, No 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Shiyi Dai
- Department of Pediatric Surgery, West China Hospital of Sichuan University, No 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Chenyu Liu
- Department of Pediatric Surgery, West China Hospital of Sichuan University, No 37, Guo Xue Xiang, Chengdu, 610041, China
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Abstract
Congenital lung malformations represent a spectrum of lesions, each with a distinct cause and tailored clinical approach. This article will focus on the following malformations: congenital pulmonary airway malformations, formally known as congenital cystic adenomatoid malformations, bronchopulmonary sequestration, congenital lobar emphysema, and bronchogenic cyst. Each of these malformations will be defined and examined from an embryologic, pathophysiologic, and clinical management perspective unique to that specific lesion. A review of current recommendations in both medical and surgical management of these lesions will be discussed as well as widely accepted treatment algorithms.
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Affiliation(s)
- Brittany N Hegde
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, USA; Center for Surgical Trials and Evidence-Based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, USA
| | - KuoJen Tsao
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, USA; Center for Surgical Trials and Evidence-Based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, USA
| | - Shinjiro Hirose
- Division of Pediatric, Thoracic, and Fetal Surgery, University of California-Davis Medical Center, 2335 Stockton Boulevard, Sacramento, CA 95817, USA.
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Mehl SC, Short WD, Kinley A, Olutoye OO, Lee TC, Keswani SG, King A. Maternal Steroids in High-Risk Congenital Lung Malformations. J Surg Res 2022; 280:312-319. [PMID: 36030607 DOI: 10.1016/j.jss.2022.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/15/2022] [Accepted: 07/27/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION The purpose of the present study is to evaluate our institutional management of high-risk congenital lung malformations (CLM) with particular consideration of the use of multiple maternal steroid courses and maternal steroids in CLMs with pathologies other than congenital pulmonary airway malformation (CPAM). METHODS A single-center retrospective review was performed for all fetuses evaluated for CLM who received maternal steroids and/or had a CLM volume ratio (CVR) ≥ 1.6 (2015-2020). Fetuses were categorized as receiving no steroids, single steroid, or multiple steroid courses. Outcomes evaluated included CVR growth rate, resolution of early hydrops, and resolution of hydrops. Results are reported with a descriptive analysis. RESULTS Nineteen patients were identified who had CVR ≥ 1.6 (single steroid course 9/19, multiple steroid courses 6/19, and no steroids 4/19). A majority (n = 13, 68%) of all lesions had a reduction or no change in CVR between initial and final measurements (single steroid course 7/9, 78%; multiple steroid courses 4/6, 67%). When evaluating by pathology, ≥ 50% of each classification had reduction or no growth of CVR (CPAM 7/11, bronchial atresia 2/4, sequestration 3/3, congenital lobar emphysema 1/1). Seventy five percent (3/4) of lesions with early hydrops had resolution following steroid treatment (single steroid course 1, multiple steroid courses 2). Of the four lesions that had hydrops, only one had resolution after receiving multiple steroid courses. CONCLUSIONS Our institutional experience reports the majority of CLM (including pathologies other than CPAM) who received steroids had reduction or no change in CVR. Given the low risk-benefit ratio of maternal steroids, physicians could consider use of multiple steroid courses for CLM refractory to a single course.
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Affiliation(s)
- Steven C Mehl
- Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas.
| | - Walker D Short
- Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas
| | - Austin Kinley
- Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Oluyinka O Olutoye
- Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas
| | - Timothy C Lee
- Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas
| | - Sundeep G Keswani
- Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas
| | - Alice King
- Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas
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Yuan M, Xu C, Luo D, Cheng K, Yang G, He T. A Novel Surgical Method for Congenital Lung Malformations: A Pilot Study. Semin Thorac Cardiovasc Surg 2022; 35:541-547. [PMID: 35809837 DOI: 10.1053/j.semtcvs.2022.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 02/08/2023]
Abstract
Thoracoscopic surgery for congenital lung malformations (CLMs) has been widely used. However, there are still many shortcomings in the current surgical methods, such as the removal of some normal lung tissue and residual lesions. Thoracoscopic anatomical lesion resection (TALR) may be an effective and safe method to resolve these problems. This retrospective study was conducted to estimate the safety and efficiency of TALR. A retrospective review of clinical data involving patients who underwent TALR in our hospital from October 2019 to January 2021 was performed. Clinical data, including patients' demographic characteristics, manipulative details, and postoperative complications, were extracted and analyzed. A total of 95 cases were included in this study. All cases were operated on under thoracoscope, with no conversion to open surgery. The average operation time was 63.2 ± 15.2 min (range 36-142 min). The average bleeding volume during the operation was 5.8 ± 2.1 mL (range 2-10 mL). The mean diameter of the lesion was 4.4 ± 1.9 cm (range 3-7 cm). All cases had no complications, such as bronchopleurothelial fistula, hemorrhage, atelectasis, or pulmonary infection. Two patients developed pneumothorax 1 month after the operation and were cured by closed thoracic drainage. One month after the operation, chest CT showed regular cysts in 2 cases. The other patients were followed up for over 1 year by chest CT after the operation, and all recovered well without residual lesions or recurrence. Combined with the preoperative thin slice CT and intraoperative lesion boundary, anatomical intrapulmonary dissociation based on the pulmonary vein system, TALR, as a lung-sparing surgery of completely removing the lesion and retaining all normal lung tissue, has high safety and effectiveness in the treatment of CLMs.
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Affiliation(s)
- Miao Yuan
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, China
| | - Chang Xu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, China.
| | - Dengke Luo
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, China
| | - Kaisheng Cheng
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, China
| | - Gang Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, China
| | - Taozhen He
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, China
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Weller JH, Peter SDS, Fallat ME, Saito JM, Burns CR, Deans KJ, Fraser JD, Gadepalli SK, Helmrath MA, Hirschl RB, Kabre R, Lal DR, Landman MP, Leys CM, Mak GZ, Minneci PC, Wright TN, Kunisaki SM. Thoracoscopic versus open lobectomy in infants with congenital lung malformations: A multi-institutional propensity score analysis. J Pediatr Surg 2021; 56:2148-2156. [PMID: 34030879 DOI: 10.1016/j.jpedsurg.2021.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/18/2021] [Accepted: 04/15/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The impact of thoracoscopic surgery on outcomes in children with congenital lung malformations (CLM) remains controversial. The purpose of this study was to determine the effect of operative approach on perioperative outcomes in infants undergoing lobectomy for an asymptomatic CLM. METHODS After IRB approval, a retrospective cohort study was conducted on 506 children with a CLM resected at one of eleven children's hospitals over a seven-year period. Infants undergoing elective lobectomy were identified, and covariates were balanced based on operative approach using propensity scores with full matching. Outcomes were analyzed based on intention to treat with weighted conditional regression. RESULTS One hundred seventy-five infants met inclusion criteria. There were 67 (38.3%) open, 89 (50.9%) thoracoscopic, and 19 (10.9%) thoracoscopic-converted-to-open lobectomies. Thoracoscopic lobectomy was associated with significantly longer operative times (26 min, 95% CI 6-47 min, p = 0.012) but used less epidural anesthesia (OR 0.02, 95% CI 0.004-0.11, p<0.001) when compared to open lobectomy. There were no significant differences in intraoperative blood loss, postoperative complications, chest tube duration, or length of stay. CONCLUSIONS Thoracoscopy has become the most common operative approach for elective lobectomy in infants with asymptomatic CLMs. The non-inferiority of thoracoscopic lobectomy in postoperative outcomes supports its continued use as an alternative to open lobectomy. LEVEL OF EVIDENCE Treatment study, Level III.
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Affiliation(s)
- Jennine H Weller
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, Baltimore, MD, United States
| | | | - Mary E Fallat
- Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Norton Children's Hospital, Louisville, KY, United States
| | - Jacqueline M Saito
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Cartland R Burns
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Katherine J Deans
- Center for Surgical Outcomes Research, the Research Institute and Department of Surgery, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, United States
| | - Jason D Fraser
- Children's Mercy Hospital, Kansas City, MO, United States
| | - Samir K Gadepalli
- University of Michigan and Michigan Medicine, C.S. Mott Children's Hospital, Ann Arbor, MI, United States
| | - Michael A Helmrath
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Ronald B Hirschl
- University of Michigan and Michigan Medicine, C.S. Mott Children's Hospital, Ann Arbor, MI, United States
| | - Rashmi Kabre
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Dave R Lal
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Matthew P Landman
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Charles M Leys
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI, United States
| | - Grace Z Mak
- Section of Pediatric Surgery, Department of Surgery, Comer Children's Hospital, University of Chicago Medicine and Biological Sciences, Chicago, IL, United States
| | - Peter C Minneci
- Center for Surgical Outcomes Research, the Research Institute and Department of Surgery, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, United States
| | - Tiffany N Wright
- Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Norton Children's Hospital, Louisville, KY, United States
| | - Shaun M Kunisaki
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, Baltimore, MD, United States.
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Yang W, Zhao P, Liu Y, Cao P, Ji X, Gao Y, Li P, Cheng J. Transcriptome analysis of lncRNA expression patterns in human congenital lung malformations. BMC Genomics 2021; 22:861. [PMID: 34844556 PMCID: PMC8630864 DOI: 10.1186/s12864-021-08204-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives To explore the long non-coding RNA (lncRNA) expression pattern of congenital lung malformations on a genome-wide scale and investigate their potential biological function in four subtypes of congenital lung malformations. Methods We obtained both lesions and normal lung control tissues from the patients diagnosed with CPAM-I, CPAM-II, ILS, and ILS-CPAM, and underwent lobectomy (i.e., surgical removal of the whole lobe which contains the localized lesion as well as normal lung tissue). Then, we performed lncRNA transcriptome profiling in these tissues by RNA sequencing (RNA-seq). A comprehensive bioinformatics analysis was conducted to characterize the expression profiles and relevant biological functions and for multiple comparisons of lncRNA expression in the different subtypes of congenital lung malformation tissues. Furthermore, the lncRNA-mRNA co-expression network was constructed, and dysregulated mRNAs were functionally analyzed. Finally, gene set enrichment analysis (GSEA) was used to predict the potential molecular mechanism of the identified lncRNAs. Results A total of 5921 lncRNA transcripts were identified between congenital lung malformations tissues and normal lung control tissues. Compared with normal lung control, 481of these expressed lncRNAs were upregulated and 142 were downregulated in CPAM-I, 91 were upregulated and 14 were downregulated in CPAM-II, 39 were upregulated and 38 were downregulated in ILS, and 201 were upregulated and 38 were downregulated in ILS-CPAM. Unsupervised clustering and principal component analysis of the expressed lncRNAs visualized the differences between normal lung control and different subtypes of congenital lung malformations samples. We also confirmed significant differences in the composition of differentially expressed genes (DEGs) and the differentially expressed lncRNAs (DE lncRNAs) between CPAM-I and other subtypes of congenital lung malformations, as well as in normal lung control tissues, and observed enrichment of DEGs in the regulation of the immune system, cell projection organization, and inflammatory pathways. Finally, we identified the lncRNA FLJ26850 might be related to congenital lung malformations via ZNF473. Conclusions Significant differences in lncRNAs expression patterns were observed between different subtypes of congenital lung malformations and normal control. The lncRNA FLJ26850 might be related to congenital lung malformations via ZNF473. Supplementary Information The online version contains supplementary material available at 10.1186/s12864-021-08204-x.
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Affiliation(s)
- Weili Yang
- Department of Pediatric Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, No. 157, Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Pu Zhao
- Department of Neonatology, the third Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710068, Shaanxi Province, China
| | - Yun Liu
- Department of Respiratory Medicine, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China
| | - Ping Cao
- Department of Pediatric Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, No. 157, Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Xiang Ji
- Department of Pediatric Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, No. 157, Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Ya Gao
- Department of Pediatric Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, No. 157, Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Peng Li
- Department of Pediatric Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, No. 157, Xiwu Road, Xi'an, 710004, Shaanxi, China.
| | - Jiwen Cheng
- Department of Pediatric Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, No. 157, Xiwu Road, Xi'an, 710004, Shaanxi, China.
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Tivnan P, Winant AJ, Epelman M, Lee EY. Pediatric Congenital Lung Malformations: Imaging Guidelines and Recommendations. Radiol Clin North Am 2021; 60:41-54. [PMID: 34836565 DOI: 10.1016/j.rcl.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Congenital lung malformations are a spectrum of developmental anomalies comprised of malformations of the lung parenchyma, airways, and vasculature. Imaging assessment plays a pivotal role in the initial diagnosis, management, and follow-up evaluation of congenital lung malformations in the pediatric population. However, there is currently a lack of practical imaging guidelines and recommendations for the diagnostic imaging assessment of congenital lung malformations in infants and children. This article reviews the current evidence regarding the imaging evaluation of congenital lung malformations and provides up-to-date imaging recommendations for pediatric congenital lung malformations.
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Affiliation(s)
- Patrick Tivnan
- Department of Radiology, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, USA.
| | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Monica Epelman
- Department of Radiology, Nemours Children's Health System/Nemours Children's Hospital, 6535 Nemours Parkway, Orlando, FL 32827, USA
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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10
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Elhattab A, Elsaied A, Wafa T, Jugie M, Delacourt C, Sarnacki S, Aly K, Khen-Dunlop N. Thoracoscopic surgery for congenital lung malformations: Does previous infection really matter? J Pediatr Surg 2021; 56:1982-1987. [PMID: 33573805 DOI: 10.1016/j.jpedsurg.2021.01.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/13/2021] [Accepted: 01/19/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND/ PURPOSE Elective resection of congenital lung malformations (CLMs) is still debatable. The two main risks are malignant transformation and recurrent pulmonary infections. Our study aimed to assess the effect of previous pulmonary infection on the intraoperative and postoperative courses of thoracoscopic surgery for CLMs. METHODS This is a retrospective study including all thoracoscopic lung resections for CLMs between 2010 and 2019. Ninety patients were included. There was a history of previous pulmonary infection in 28 patients (group A) and no such history in 62 patients (group B). RESULTS The median age at operation for group A was 20.4 months (IQR:14.9-41.4) versus 15.1 months (IQR:9.7-20.8) in group B (p = 0.006). There were 10 conversions (35.7%) in group A and 8 (12.9%) in group B (p = 0.02). The operative time was significantly shorter in group B (p<0.002). In group A, 32.1% of patients experienced postoperative fever versus 11.3% of group B (p = 0.03), with higher antibiotics requirement (28.6% versus 6.5% respectively, p = 0.007). However, no significant differences were found in terms of postoperative complications (p = 0.99). CONCLUSION Earlier intervention for CLMs before the development of pulmonary infection carries higher chances for the success of the thoracoscopic approach with shorter operative time and more uneventful postoperative courses.
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Affiliation(s)
- Ahmad Elhattab
- Department of Pediatric Surgery, AP-HP, Necker-Enfants malades Hospital, Paris, France; Department of Pediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Adham Elsaied
- Department of Pediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Tamer Wafa
- Department of Pediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Myriam Jugie
- Intensive care Unit, AP-HP, Necker-Enfants malades Hospital, Paris, France
| | - Christophe Delacourt
- Department of Pediatric Pulmonology, AP-HP, Necker-Enfants malades Hospital, Paris, France; Université de Paris, Paris, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery, AP-HP, Necker-Enfants malades Hospital, Paris, France; Université de Paris, Paris, France
| | - Kamal Aly
- Department of Pediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Naziha Khen-Dunlop
- Department of Pediatric Surgery, AP-HP, Necker-Enfants malades Hospital, Paris, France; Université de Paris, Paris, France
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11
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Yang W, Shen C, Yu N, Guo Y, Pan W, Li P, Gao Y, Chen X, Cheng J. Computer-aided quantitative MSCT measurements may be useful for congenital lung malformations surgical approach selection. Pediatr Surg Int 2021; 37:1273-1280. [PMID: 34213588 DOI: 10.1007/s00383-021-04949-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine the association between the MSCT quantitative measurements of congenital lung malformations (CLM) and the selection of surgical approaches (lobectomy vs. lung-sparing surgery). METHODS This retrospective study evaluated CLM surgical cases at our institution from 2016 to 2018. MSCT quantitative measurements were generated by a semi-automated approach: the volume of the lesion (Vlesion), the volume of the lesion-involved lobe (Vlobe), the volume of the lesion-involved lung (Vlung) and the volume of the total lung (Vtotal lung). The proportions of Vlesion to Vlobe (Plesion/lobe), Vlesion to Vlung (Plesion/lung), and Vlesion to V total lung (Plesion/total lung) were calculated. We used Logistics regression to examine whether quantitative measurements were associated with the selection of surgical approaches. RESULTS 151 patients were included (median age at surgery 6 months). 82 patients underwent lung-sparing surgery, and 69 patients underwent lobectomy. Vlesion (OR 1.51, 95% CI 1.09-2.07), Plesion/lobe (OR 1.78, 95% CI 1.16-2.72), Plesion/lung (OR 1.63, 95% CI 1.13-2.35), and Plesion/total lung (OR 1.58, 95% CI 1.12-2.22) were positively associated with the selection of lobectomy. CONCLUSION The application of quantified MSCT analysis may provide insight into the quantitative characteristics of CLM, which could be potentially useful for surgical approach selection.
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Affiliation(s)
- Weili Yang
- Department of Pediatric Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Five Road, Xi'an, 710004, Shaanxi, China
| | - Cong Shen
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Nan Yu
- Department of Medical Imaging, The Affiliated Hospital of Shaanxi Chinese Medicine University, Xianyang, 712000, Shaanxi, China
| | - Youmin Guo
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Weikang Pan
- Department of Pediatric Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Five Road, Xi'an, 710004, Shaanxi, China
| | - Peng Li
- Department of Pediatric Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Five Road, Xi'an, 710004, Shaanxi, China
| | - Ya Gao
- Department of Pediatric Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Five Road, Xi'an, 710004, Shaanxi, China
| | - Xin Chen
- Department of Medical Imaging, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Five Road, Xi'an, 710004, Xi'an, China.
| | - Jiwen Cheng
- Department of Pediatric Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Five Road, Xi'an, 710004, Shaanxi, China.
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12
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Abstract
Congenital bronchopulmonary malformations are relatively common and arise during various periods of morphogenesis. Although some are isolated or sporadic occurrences, others may result from single gene mutations or cytogenetic imbalances. Single gene mutations have been identified, which are etiologically related to primary pulmonary hypoplasia, lung segmentation defects as well as pulmonary vascular and lymphatic lesions. Functional defects in cystic fibrosis, primary ciliary dyskinesias, alpha-1-antitrypsin deficiency, and surfactant proteins caused by gene mutations may result in progressive pulmonary disease. This article provides an overview of pediatric pulmonary disease from a genetic perspective.
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Affiliation(s)
- Beth A Pletcher
- Department of Pediatrics, Rutgers New Jersey Medical School, Newark, NJ, USA.
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13
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Affiliation(s)
- Shaun M Kunisaki
- Division of General Pediatric Surgery, Johns Hopkins Children's Center, Johns Hopkins University, Johns Hopkins University School of Medicine, 1800 Orleans Street, Suite 7353, Baltimore, MD 21287, USA.
| | - Charles M Leys
- Division of Pediatric Surgery, University of Wisconsin School of Medicine and Public Health, American Family Children's Hospital, 600 Highland Avenue, H4/740 CSC, Madison, WI 53792-7375, USA
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14
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Kunisaki SM, Saito JM, Fallat ME, St Peter SD, Lal DR, Johnson KN, Mon RA, Adams C, Aladegbami B, Bence C, Burns RC, Corkum KS, Deans KJ, Downard CD, Fraser JD, Gadepalli SK, Helmrath MA, Kabre R, Landman MP, Leys CM, Linden AF, Lopez JJ, Mak GZ, Minneci PC, Rademacher BL, Shaaban A, Walker SK, Wright TN, Hirschl RB. Development of a multi-institutional registry for children with operative congenital lung malformations. J Pediatr Surg 2020; 55:1313-1318. [PMID: 30879756 DOI: 10.1016/j.jpedsurg.2019.01.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/27/2018] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The purpose of this study was to develop a multi-institutional registry to characterize the demographics, management, and outcomes of a contemporary cohort of children undergoing congenital lung malformation (CLM) resection. METHODS After central reliance IRB approval, a web-based, secure database was created to capture retrospective cohort data on pathologically-confirmed CLMs performed between 2009 and 2015 within a multi-institutional research collaborative. RESULTS Eleven children's hospitals contributed 506 patients. Among 344 prenatally diagnosed lesions, the congenital pulmonary airway malformation volume ratio was measured in 49.1%, and fetal MRI was performed in 34.3%. One hundred thirty-four (26.7%) children had respiratory symptoms at birth. Fifty-eight (11.6%) underwent neonatal resection, 322 (64.1%) had surgery at 1-12 months, and 122 (24.3%) had operations after 12 months. The median age at resection was 6.7 months (interquartile range, 3.6-11.4). Among 230 elective lobectomies performed in asymptomatic patients, thoracoscopy was successfully utilized in 102 (44.3%), but there was substantial variation across centers. The most common lesions were congenital pulmonary airway malformation (n = 234, 47.3%) and intralobar bronchopulmonary sequestration (n = 106, 21.4%). CONCLUSION This multicenter cohort study on operative CLMs highlights marked disease heterogeneity and substantial practice variation in preoperative evaluation and operative management. Future registry studies are planned to help establish evidence-based guidelines to optimize the care of these patients. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Shaun M Kunisaki
- Section of Pediatric Surgery, Department of Surgery, University of Michigan and Michigan Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI, USA.
| | - Jacqueline M Saito
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Mary E Fallat
- Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Norton Children's Hospital, Louisville, KY, USA
| | - Shawn D St Peter
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Dave R Lal
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kevin N Johnson
- Section of Pediatric Surgery, Department of Surgery, University of Michigan and Michigan Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI, USA
| | - Rodrigo A Mon
- Section of Pediatric Surgery, Department of Surgery, University of Michigan and Michigan Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI, USA
| | - Cheryl Adams
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Bola Aladegbami
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Christina Bence
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - R Cartland Burns
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kristine S Corkum
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katherine J Deans
- Center for Surgical Outcomes Research, the Research Institute and Department of Surgery, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, USA
| | - Cynthia D Downard
- Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Norton Children's Hospital, Louisville, KY, USA
| | - Jason D Fraser
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Samir K Gadepalli
- Section of Pediatric Surgery, Department of Surgery, University of Michigan and Michigan Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI, USA
| | - Michael A Helmrath
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Rashmi Kabre
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Matthew P Landman
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Charles M Leys
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Allison F Linden
- Section of Pediatric Surgery, Department of Surgery, Comer Children's Hospital, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA
| | - Joseph J Lopez
- Center for Surgical Outcomes Research, the Research Institute and Department of Surgery, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, USA
| | - Grace Z Mak
- Section of Pediatric Surgery, Department of Surgery, Comer Children's Hospital, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA
| | - Peter C Minneci
- Center for Surgical Outcomes Research, the Research Institute and Department of Surgery, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, USA
| | - Brooks L Rademacher
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Aimen Shaaban
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sarah K Walker
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Tiffany N Wright
- Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Norton Children's Hospital, Louisville, KY, USA
| | - Ronald B Hirschl
- Section of Pediatric Surgery, Department of Surgery, University of Michigan and Michigan Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI, USA
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15
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Cheng KS, Yuan M, Xu C, Yang G, Zhou Y. [Retrospective Analysis on the Safety and Feasibility of Thoracoscopic Anatomical Segmentectomy in the Treatment of Congenital Lung Malformations]. Sichuan Da Xue Xue Bao Yi Xue Ban 2019; 50:594-597. [PMID: 31642241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the safety and feasibility of thoracoscopic anatomical pulmonary segmentectomy in children with congenital lung malformations. METHODS A retrospective review was conducted to analyze clinical data of children thoracoscopic anatomical pulmonary segmentectomy performed in West China Hospital of Sichuan University from Jan. 2014 to Sept. 2018. RESULTS A total of 151 cases were recorded, including 73 males and 78 females. The average age was 9.8 months, ranging from 5 months to 13.3 years. All the patients underwent thoracoscopic surgery without conversion to open. The average operation time was 66 min, the average amount of bleeding was 5.9 mL and the average size was 4.8 cm. Two children had air leakage after the operation, but recovered after one-week tube drainage and conservative observation therapy. 56 children had postoperative fever in varying degrees, which gradually recovered 2-3 d after operation. No postoperative complications occurred such as bronchial fistula, hemorrhage, atelectasis and pulmonary infection. Postoperative pathological results showed that there were 108 cases of congenital pulmonary airway malformation and 43 cases of intralobar pulmonary sequestration. The median follow-up time was chest computed tomography of follow-up showed that all patients recovered well without recurrence. CONCLUSION On the basis of thoracoscopic meticulous anatomy of lung lobes, Thoracoscopic anatomical segmentectomy in children is safe and feasible as a lung sparing resection.
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Affiliation(s)
- Kai-Sheng Cheng
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Miao Yuan
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chang Xu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Gang Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yin Zhou
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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16
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Kunisaki SM, Saito JM, Fallat ME, St Peter SD, Kim AG, Johnson KN, Mon RA, Adams C, Aladegbami B, Bence C, Burns RC, Corkum KS, Deans KJ, Downard CD, Fraser JD, Gadepalli SK, Helmrath MA, Kabre R, Lal DR, Landman MP, Leys CM, Linden AF, Lopez JJ, Mak GZ, Minneci PC, Rademacher BL, Shaaban A, Walker SK, Wright TN, Hirschl RB; Midwest Pediatric Surgery Consortium. Current operative management of congenital lobar emphysema in children: A report from the Midwest Pediatric Surgery Consortium. J Pediatr Surg 2019; 54:1138-42. [PMID: 30898401 DOI: 10.1016/j.jpedsurg.2019.02.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/21/2019] [Indexed: 02/01/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical presentation and operative outcomes of patients with congenital lobar emphysema (CLE) within a large multicenter research consortium. METHODS After central reliance IRB-approval, a retrospective cohort study was performed on all operatively managed lung malformations at eleven participating children's hospitals (2009-2015). RESULTS Fifty-three (10.5%) children with pathology-confirmed CLE were identified among 506 lung malformations. A lung mass was detected prenatally in 13 (24.5%) compared to 331 (73.1%) in non-CLE cases (p < 0.0001). Thirty-two (60.4%) CLE patients presented with respiratory symptoms at birth compared to 102 (22.7%) in non-CLE (p < 0.0001). The most common locations for CLE were the left upper (n = 24, 45.3%), right middle (n = 16, 30.2%), and right upper (n = 10, 18.9%) lobes. Eighteen (34.0%) had resection as neonates, 30 (56.6%) had surgery at 1-12 months of age, and five (9.4%) had resections after 12 months. Six (11.3%) underwent thoracoscopic excision. Median hospital length of stay was 5.0 days (interquartile range, 4.0-13.0). CONCLUSIONS Among lung malformations, CLE is associated with several unique features, including a low prenatal detection rate, a predilection for the upper/middle lobes, and infrequent utilization of thoracoscopy. Although respiratory distress at birth is common, CLE often presents clinically in a delayed and more insidious fashion. LEVEL OF EVIDENCE Level III.
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17
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Al Absi HS, Konstantinopoulou S, Al Junaibi AA, Abdullah MF, Sharma V, Al Marzooqi S. Type I regressed pleuropulmonary blastoma in a 10-year-old boy. Indian J Thorac Cardiovasc Surg 2019; 35:579-83. [PMID: 33061055 DOI: 10.1007/s12055-019-00814-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/24/2019] [Accepted: 02/26/2019] [Indexed: 10/26/2022] Open
Abstract
Pleuropulmonary blastoma (PPB) is a rare, malignant tumor of the lung and is the most common primary pulmonary malignancy in children. Here, we report a case of a boy who was diagnosed with type I regressed PPB after being mislabeled with congenital pulmonary malformation. A 10-year-old boy presented to our hospital with a history of worsening dyspnea. Since birth, his clinical status and radiographic images were concerning for congenital lobar emphysema that was managed conservatively. A chest computed tomography (CT) scan confirmed the persistence of a large cystic lesion and a diagnostic and therapeutic cystectomy was performed. Microscopic examination confirmed the presence of PPB type Ir. Patient was managed surgically alone with no added chemotherapy, as there was no overall survival benefit. PPB Ir has an overall favorable clinical outcome. Limited follow-up data are available due to the rarity of the lesion and the overlap with other congenital cystic lung malformations.
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Greig CJ, Keiser AM, Cleary MA, Stitelman DH, Christison-Lagay ER, Ozgediz DE, Solomon DG, Caty MG, Cowles RA. Routine postnatal chest x-ray and intensive care admission are unnecessary for a majority of infants with congenital lung malformations. J Pediatr Surg 2019; 54:670-674. [PMID: 30503193 DOI: 10.1016/j.jpedsurg.2018.10.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 10/06/2018] [Accepted: 10/21/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postnatal evaluation of prenatally identified congenital lung malformations (CLMs) often includes a chest x-ray (CXR) and neonatal intensive care unit (NICU) admission for observation. With current efforts aimed at prioritizing value and resource utilization, we sought to assess the utility of this practice in infants with known CLMs. We hypothesized that CXR and NICU admission are overused and could be deferred in the majority of cases. METHODS Clinical and radiographic data for infants with CLM from 2007 to 2016 were reviewed with IRB approval. Regression models were developed for respiratory support (RS), symptoms within 30 days of discharge (Sx30), and abnormal CXR. Predictors included initial symptoms (IS), birth weight (BW), gestational age (GA), cyst-volume-ratio (CVR) and abnormal CXR. Odds ratios (ORs) and ROC curves were generated for significant predictors (p < 0.05). RESULTS Fifty-eight infants were identified. Eight were excluded because birth or surgery occurred outside of our institution. Another four were excluded for requiring immediate surgery, leaving forty-six for full analysis. All infants underwent initial CXR and NICU admission, and 22 (47.8%) had an abnormal CXR. Higher CVR (OR = 6.69, p = 0.024) and lower BW (OR = 0.27, p = 0.028) both increased the odds of an abnormal CXR. Applying optimal ROC cutoffs for CVR and BW would have safely eliminated 21 of 46 CXRs, increasing CXR sensitivity from 48% to 68%. For RS and Sx30, no variable, including abnormal CXR, significantly predicted outcomes. Twenty-seven infants (59%) had a NICU stay of <24 h and only three patients (6.8%) developed Sx30. CONCLUSIONS Both CXR and NICU admission appear to be overused in infants with CLM. CXR result did not predict need for respiratory support or symptoms following discharge, and thus may not aid in the initial evaluation or in the prediction of future care needs. Using CVR and birth weight can guide CXR use and optimize its sensitivity. Need for NICU admission could not be predicted, but a majority of infants spent <24 h in the NICU without intervention, suggesting that NICU admission was likely not needed for all infants in this setting. LEVEL OF EVIDENCE Study of diagnostic test, Level II evidence.
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Affiliation(s)
- Chasen J Greig
- Yale School of Medicine, 330 Cedar Street, New Haven, CT
| | - Amaris M Keiser
- Yale School of Medicine, 330 Cedar Street, New Haven, CT; The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD
| | | | | | | | | | | | - Michael G Caty
- Yale School of Medicine, 330 Cedar Street, New Haven, CT
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Seear M, Townsend J, Hoepker A, Jamieson D, McFadden D, Daigneault P, Glomb W. A review of congenital lung malformations with a simplified classification system for clinical and research use. Pediatr Surg Int 2017; 33:657-664. [PMID: 28204920 DOI: 10.1007/s00383-017-4062-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Congenital lung abnormalities are rare malformations increasingly detected early by prenatal ultrasound. Whether management of these frequently asymptomatic lesions should be surgical or conservative is an unresolved issue. The necessary prospective studies are limited by the absence of a widely accepted practical classification system. Our aim was to develop a simple, clinically relevant system for classifying and studying congenital lung abnormalities. MATERIALS AND METHODS We based our proposed grouping on a detailed analysis of clinical, radiological, and histological data from well-documented cases, plus an extensive review of the literature. RESULTS The existence of hybrid lesions and common histological findings suggested a unified embryological mechanism-possibly obstruction of developing airways with distal dysplasia. Malformations could be classified by their anatomical and pathological findings; however, a system based on the prenatal ultrasound plus initial chest X-ray findings had greater clinical relevance: Group 1-Congenital solid/cystic lung malformation, Group 2-Congenital hyperlucent lobe, Group 3-Congenital small lung. CONCLUSIONS Pathological classification is academically important but is unnecessarily complex for clinical and research use. Our simple radiological-based system allows unambiguous comparison between the results of different studies and also guides the choice of necessary investigations specific to each group.
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Affiliation(s)
- Michael Seear
- Divisions of Respiratory Medicine, British Columbia's Children's Hospital, Room 1C 31, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
| | - Jennifer Townsend
- Divisions of Respiratory Medicine, British Columbia's Children's Hospital, Room 1C 31, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada
| | - Amy Hoepker
- Divisions of Respiratory Medicine, British Columbia's Children's Hospital, Room 1C 31, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada
| | - Douglas Jamieson
- Divisions of Radiology, British Columbia's Children's Hospital, Vancouver, Canada
| | - Deborah McFadden
- Divisions of Pathology, British Columbia's Children's Hospital, Vancouver, Canada
| | - Patrick Daigneault
- Division of Pediatric Respirology, Centre Mere-Enfant du CHUQ, Universite Laval, Quebec, Canada
| | - William Glomb
- Division of Pediatric Pulmonology, University of Texas Medical Branch, Austin, USA
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Lee S, Kim DH, Lee SK. Efficacy of segmental resection in patients with prenatally diagnosed congenital lung malformations. Interact Cardiovasc Thorac Surg 2017; 24:425-429. [PMID: 28040760 DOI: 10.1093/icvts/ivw408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 11/17/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives Lung segmental resection is a better treatment option than lobectomy for patients with prenatally diagnosed congenital lung malformations (CLMs). However, data are lacking on the effects of this procedure in prenatally diagnosed CLM patients. In this study, we explored whether parenchyma-saving resection was feasible in patients with this condition. Methods A retrospective analysis was performed on 27 patients prenatally diagnosed with CLM, who subsequently underwent surgery between March 2011 and September 2015. Lobectomies and segmental resections were performed in 7 and 20 patients, respectively, based on the extent of cystic lesion invasion. Results The operative time significantly differed between the two groups (lobectomy group, 92.9 ± 32.0 min; segmental resection group, 126.5 ± 37.5 min). However, the duration of chest tube drainage and the length of hospital stay did not significantly differ between the groups. Chest computed tomography (CT) was performed during follow-up on all but 3 patients. We encountered 2 cases of remnant lesions, and one instance of a small emphysematous lesion around the surgical site was noted in either group. Conclusions Lung-sparing surgery is relatively safe with few complications. In this study, the incidence of remnant lung lesions (a drawback of segmentectomy) was low. Thus, segmental resection affords results similar to those of lobectomy in patients with prenatally diagnosed CLM. Furthermore, segmental resection can preserve lung volume, thereby maintaining later pulmonary function. Therefore, elective segmental resection performed after precise identification of the lesions' locations may be highly beneficial for CLM patients.
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Affiliation(s)
- Sungkwang Lee
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Kyungheedae-ro, Dongdaemun-gu, Seoul, Republic of Korea.,Department of Acupuncture and Moxibustion, Kyung Hee University Korean Medicine Hospital, Kyungheedae-ro, Dongdaemun-gu, Seoul, Republic of Korea
| | - Do Hyung Kim
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sang Kwon Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Casagrande A, Pederiva F. Association between Congenital Lung Malformations and Lung Tumors in Children and Adults: A Systematic Review. J Thorac Oncol. 2016;11:1837-1845. [PMID: 27423390 DOI: 10.1016/j.jtho.2016.06.023] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/26/2016] [Accepted: 06/30/2016] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The appropriate management of asymptomatic congenital pulmonary malformations (CPMs) remains controversial. Prophylactic surgery is recommended to avoid the risk for development of pulmonary infections and to prevent the highly debated development of malignancy. However, the true risk for development of malignancy remains unknown. A systematic review analyzed all cases in which lung tumors associated with CPMs in both the pediatric and adult populations were described. METHODS A comprehensive literature search was carried out; it included all the cases in which an association between CPMs and malignant pulmonary lesions was reported. RESULTS In all, 134 publications were eligible for inclusion. In 168 patients CPM was found associated with lung tumor. The diagnosis was made in 76 children at a mean age of 3.68 ± 3.4, whereas in the adult population (n = 92) it was made at a mean age of 44.62 ± 16.09. Cough was the most frequent presenting symptom both in children and in adults. Most of the patients underwent lobectomy. The tumor most often associated with CPM was pleuropulmonary bastoma in children (n = 31) and adenocarcinoma (n = 20) or bronchioloalveolar carcinoma (n = 20) in adults. The CPM most frequenty associated with tumors in children was congenital cystic adenomatoid malformation (n = 37), especially type 1 (n = 21), whereas in adults it was bronchogenic cyst (n = 25), followed by congenital cystic adenomatoid malformation (n = 21). CONCLUSIONS CPMs should be followed up and never underestimated because they may conceal a tumor. Apparently, there is no age limit for malignant progression of CPMs and no limit of the interval between first detection of the CPM and appearance of the associated tumor.
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Abstract
The controversy surrounding the management of congenital lung malformations (CLMs) centre on how best to manage the increasing population of asymptomatic antenatally detected infants. Should elective surgery be offered? Or is a "watch-and-wait" policy safe? This will be addressed in this review by examining the reported complications of surgery, the risk of symptom development if lesions are left in situ and whether this may alter surgical outcomes, and importantly whether there is any long-term risk of malignancy that can be negated by surgical resection in infancy.
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Affiliation(s)
- Michael Stanton
- Department of Paediatric Surgery, University Hospital Southampton, Tremona Road, Southampton SO16 6YD, UK.
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Abstract
Congenital lung malformations are a heterogeneous group of anomalies that involve the lungs and tracheobronchial tree (congenital airway pulmonary malformation, bronchial atresia, bronchogenic cyst, congenital lobar overinflation, pulmonary cyst, hamartoma, pulmonary isomerism and azygous lobe), vascular abnormalities (arteriovenous malformations, anomalous pulmonary venous return, pulmonary artery sling, interrupted pulmonary artery, pulmonary varix, pulmonary vein stenosis and pulmonary lymphangiectasia), or frequently both entities (pulmonary sequestration, pulmonary maldevelopment and scimitar syndrome). Advances in diagnostic imaging (including sonography, multi-detector computer tomography, magnetic resonance imaging and angiography) have increased their detection during both antenatal and postnatal periods, and radiological characterisation, which in turn influence patient counselling and management stratification. An educational illustration of the clinical application in characterisation of these malformations is presented.
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Affiliation(s)
- Moti M Chowdhury
- Department of Radiology, Royal Hospital for Sick Children, 9 Sciennes Rd, Edinburgh EH9 1LF, UK.
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Cakir U, Kahvecioglu D, Alan S, Yildiz D, Akduman H, Erdeve O, Bahadir GG, Kologlu M, Atasay B, Arsan S. Extra-lobar Pulmonary Sequestration Requiring Intrauterine Thoracentesis. APSP J Case Rep 2015; 6:3. [PMID: 25628992 PMCID: PMC4288834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 07/21/2014] [Indexed: 12/02/2022] Open
Abstract
Congenital lung malformations can result in significant morbidity and mortality in children. Pulmonary sequestration is an uncommon congenital malformation of the lung that can cause complications even in fetal life. We herein present a newborn with extra-lobar sequestration (ELS) that lead to hydrops fetalis necessitating fetal intervention.
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Affiliation(s)
- Ufuk Cakir
- Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey.
| | - Dilek Kahvecioglu
- Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey.
| | - Serdar Alan
- Neonatal Intensive Care Unit, Hitit University Corum Training and Research Hospital, Corum, Turkey.
| | - Duran Yildiz
- Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey.
| | - Hasan Akduman
- Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey.
| | - Omer Erdeve
- Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey.
| | - Gulnur Gollu Bahadir
- Department of Pediatric Surgery, Ankara University School of Medicine, Ankara, Turkey.
| | - Meltem Kologlu
- Department of Pediatric Surgery, Ankara University School of Medicine, Ankara, Turkey.
| | - Begum Atasay
- Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey.
| | - Saadet Arsan
- Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey.
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Pelizzo G, Mimmi MC, Ballico M, Marotta M, Goruppi I, Peiro JL, Zambaiti E, Costanzo F, Andreatta E, Tonin E, Calcaterra V. Congenital pulmonary malformations: metabolomic profile of lung phenotype in infants. J Matern Fetal Neonatal Med 2014; 29:143-7. [PMID: 25471172 DOI: 10.3109/14767058.2014.991708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The main hydrosoluble metabolites in three different human congenital pulmonary malformations are described by nuclear magnetic resonance (NMR) spectroscopy. METHODS Bronchogenic cyst (BC), congenital lobar emphysema (CLE) and intrapulmonary sequestration (IPS), were analyzed with respect to a control sample. The extracted metabolites were submitted to high-resolution (1)H NMR-spectroscopy. RESULTS Congenital lung malformations showed free choline, phosphocoline and myoinositol high levels. IPS and CLE were found increased in lactic acid/glucose ratio. Lactic acid and glucose values resulted to be more elevated in control sample. CONCLUSIONS Congenital lung lesions showed different metabolomic profiles useful for early diagnosis.
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Affiliation(s)
- Gloria Pelizzo
- a Department of the Mother and Child Health, Pediatric Surgery Unit , IRCCS Policlinico San Matteo Foundation Pavia and University of Pavia , Pavia , Italy
| | - Maria Chiara Mimmi
- b Department of Medical and Biological Sciences , University of Udine , Udine , Italy
| | - Maurizio Ballico
- b Department of Medical and Biological Sciences , University of Udine , Udine , Italy
| | - Mario Marotta
- c Cincinnati Fetal Center, Pediatric Surgery Division, CCHMC , Cincinnati , OH , USA .,d Fetal Surgery Program, Congenital Malformations Research Group, Research Institute of Hospital Universitari Vall d'Hebron , Edifici Infantil , Barcelona , Spain
| | - Ilaria Goruppi
- a Department of the Mother and Child Health, Pediatric Surgery Unit , IRCCS Policlinico San Matteo Foundation Pavia and University of Pavia , Pavia , Italy
| | - Jose Louis Peiro
- c Cincinnati Fetal Center, Pediatric Surgery Division, CCHMC , Cincinnati , OH , USA .,d Fetal Surgery Program, Congenital Malformations Research Group, Research Institute of Hospital Universitari Vall d'Hebron , Edifici Infantil , Barcelona , Spain
| | - Elisa Zambaiti
- a Department of the Mother and Child Health, Pediatric Surgery Unit , IRCCS Policlinico San Matteo Foundation Pavia and University of Pavia , Pavia , Italy
| | - Federico Costanzo
- a Department of the Mother and Child Health, Pediatric Surgery Unit , IRCCS Policlinico San Matteo Foundation Pavia and University of Pavia , Pavia , Italy
| | - Erika Andreatta
- a Department of the Mother and Child Health, Pediatric Surgery Unit , IRCCS Policlinico San Matteo Foundation Pavia and University of Pavia , Pavia , Italy
| | - Elena Tonin
- a Department of the Mother and Child Health, Pediatric Surgery Unit , IRCCS Policlinico San Matteo Foundation Pavia and University of Pavia , Pavia , Italy
| | - Valeria Calcaterra
- e Department of the Mother and Child Health, Pediatric Unit , IRCCS Policlinico San Matteo Foundation Pavia , Pavia , Italy , and.,f Department of Internal Medicine University of Pavia , Pavia , Italy
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Abstract
Congenital lung malformations encompass a wide spectrum of conditions with a broadly varying clinical presentation. They are often a source of morbidity in infants and children. Their management depends on the type of malformation and its clinical presentation. Usually, the diagnosis requires an imaging evaluation. Classifications of bronchopulmonary malformations have undergone significant revision in recent years and several theories have attempted to explain their confusing pathogenesis. There are considerable degrees of overlapping and hybrid conditions are common, with interrelated malformations showing various radiologic and pathologic features. Attending to the pathophysiological mechanisms and structures involved, lung malformations can be divided into three categories: bronchopulmonary anomalies, combined lung and vascular abnormalities, and vascular anomalies. The purpose of this article is to review the current imaging techniques for evaluating lung malformations in pediatric patients and their characteristic imaging findings. Moreover, this review discusses a useful classification and offers some clues to facilitate the differential diagnosis.
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Affiliation(s)
- Pilar Garcia-Peña
- Pediatric Radiology Department, Hospital Universitari
Matemo-lnfantil Vail d'Hebron, Barcelona, Spain
| | - Ana Coma
- Pediatric Radiology Department, Hospital Universitari
Matemo-lnfantil Vail d'Hebron, Barcelona, Spain
| | - Goya Enríquez
- Pediatric Radiology Department, Hospital Universitari
Matemo-lnfantil Vail d'Hebron, Barcelona, Spain
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