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CCAM and sequestration: two standpoints for a single condition

Lucile Fievet¹, Xavier-Benoit D’Journo³, Benoit Dubus¹, Jean-Michel Guys², Pascal Thomas³, Thierry Merrot¹, Pascal De Lagausie²
¹Department of Pediatric Surgery, North hospital, Marseille, France, ²Department of Pediatric Surgery, Hôpital Timone Enfant, Marseille, France, ³Department of Thoracic Surgery, North hospital, Marseille, France 

 

Abstract 

Background: In adults, congenital pulmonary malformations are removed because of complications. A prenatal diagnosis is frequent, and allows an early thoracoscopic surgical treatment. A retrospective study was performed to assess management in two different populations of adults and children to define the best strategy.
Method: 52 cases (33 children, 19 adults) of pulmonary malformations followed at the University Hospital from 2000 to 2012 were reviewed. Clinical history, malformation site, duration of hospitalisation, complications, and pathology examinations were studied.
Results: In children, 28 asymptomatic cases were diagnosed prenatally and 5 during the neonatal period due to infections. Surgery was performed between 2 and 6 months of age. All the adults underwent surgery, sixteen because of complications and 3 adults for anomalies mimicking tumor.
The mean age of adult group was 42.5 years. In children, there was one thoracotomy, and 32 thoracoscopies, with 7 conversions for difficult exposure and dissection of vascular pedicles, bleeding, bronchial wounds. In the adults, there were 15 thoracotomies and only 4 thoracoscopies, with one conversion. Post-operative complications in the adults were twice as frequent then in children.
The mean time of the children’s hospitalisation was 7.75 days versus 7.16 days for the adults. Pathological examinations showed in the children: 7 sequestrations, 18 CCAM, 8 CCAM associated sequestrations and in adults: 16 sequestrations, 3 intra-pulmonary cysts.
Conclusion: Early thoracoscopic surgery allows pulmonary parenchyma conservation with pulmonary development, reduces respiratory and infectious complications, eliminates a false positive cancer diagnosis later in life and decreases risks of thoracic parietal deformation.