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Minimal invasive lung-sparing resection below 1 year of age

Sabine Vasseur Maurer, Anthony de Buys Roessingh, Olivier Reinberg

Department of Pediatric Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland



Purpose: Congenital Lung Malformations (CLM) antenatally detected bear a risk of developing infections or pneumothorax during infancy and possible late malignancies. For these reasons most authors recommend resection during the 1st year of life. Lung-sparing segmentectomies have raised interest to avoid resecting normal pulmonary tissue when performing lobectomies.
Aim: To review our experience with Minimal Invasive Lung-Sparing Resection (MILSR) below one year of age.
Method: All patients <1y. with antenatally diagnosed CLM, confirmed postnatally by 1 or 2 CT-scans, who underwent MILSR from 2007 to 2012.
Results: 14 patients ranging 4 to 12 mo (mean 7.5 mo) including 12 segmentectomies and 2 bisegmentectomies. Sex ratio m:f was 9:5. MILSR were done 6 in the right lower lobe, 2 in the right upper lobe, 4 in the left lower lobe, 2 in the left upper lobe.
5 segmentectomies were completed strictly thoracoscopically, 5 were done by thoracoscopy with a mini thoracotomy to end the dissection and extract large specimens. In 4 cases, at the very beginning of our experience, the pathologic segment was located by thoracoscopy. No conversion was done for bleeding. Chest drain was left in place for a mean duration of 2.1 d. Complications were 1 subcutaneous emphysema without consequence, 1 persistent asymptomatic pneumothorax after drain removal that resolved spontaneously, 1 viral fever.
In all cases a CLM was confirmed at pathology, but its nature or grade was different of what was suspected in 4 cases. Mean follow-up was 39 mo. All patients remain asymptomatic, with symmetrical appearance of the 2 lungs.
Conclusions: As CLM are more frequently detected due to antenatal imaging improvements, we are facing more asymptomatic cases. MILSR performed during the 1st year of life is a good and safe option to relieve the risk they bear and avoid recurrent irradiations related to radiologic observation.