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Pulmonary function after early vs late lobectomy during childhood: a preliminary study
Richard Keijzer1, Priscilla P L Chiu, Felix Ratjen
1Pediatric Surgery, Erasmus MC-Sophia, Rotterdam, The Netherlands.
Insights
Early lobectomy for congenital cystic adenomatoid malformations does not improve long-term lung function. This study found no significant difference in pulmonary function indicators between children who had early versus later surgery.
Area of Science:
- Pediatric Surgery
- Pulmonology
- Thoracic Surgery
Background:
- Congenital cystic adenomatoid malformations (CCAMs) are often resected early.
- Early resection is theorized to optimize compensatory lung growth in infants and children.
- The impact of early lobectomy on long-term pulmonary function requires investigation.
Purpose of the Study:
- To determine if early lobectomy for CCAMs is associated with improved long-term pulmonary function compared to later surgery.
- To compare pulmonary function in children undergoing lobectomy before and after 2 years of age.
Main Methods:
- Retrospective chart review of 115 children undergoing pulmonary lobectomy for benign disease (1990-2006).
- Comparison of pulmonary function tests (Forced Vital Capacity [FVC] and Forced Expiratory Volume in 1 second [FEV(1)]) between two groups: lobectomy before age 2 and after age 2.
- Impaired pulmonary function defined as FVC < 80% predicted and FEV(1) < 80% predicted.
Main Results:
- 14 patients had postoperative pulmonary function testing at a mean age of 10 years.
- No significant difference in mean FVC (81.5% vs 83.3%) or mean FEV(1) (87.6% vs 82.9%) between early and late lobectomy groups.
- Similar proportions of children in both groups exhibited impaired pulmonary function (FVC < 80% or FEV(1) < 80%).
Conclusions:
- Age at lobectomy did not significantly influence long-term FVC or FEV(1).
- Preliminary data suggest early lobectomy does not offer a pulmonary function advantage.
- A prospective study is needed to confirm these findings in a larger cohort.
Background:
One proposed reason for the early resection of asymptomatic congenital cystic adenomatoid malformations is the theoretical benefit of optimizing compensatory lung growth during infancy and early childhood. Our aim was to determine if early lobectomy is associated with better long-term pulmonary function than lobectomy later in childhood.
Methods:
A retrospective chart review of children undergoing pulmonary lobectomy for benign disease from 1990 to 2006 was performed. Those having surgery before and after 2 years of age were compared. Forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV(1)) were used as indicators of pulmonary growth, with FVC less than 80% predicted and FEV(1) less than 80% consistent with impaired pulmonary function.
Results:
Of 115 patients identified, 14 had postoperative pulmonary function testing at a mean age of 10 years. Of these, 7 had lobectomy before and 7 had lobectomy after 2 years of age. There was no significant difference between groups in mean FVC (81.5 vs 83.3) or the number of children with FVC less than 80% predicted, nor was there a difference in mean FEV(1) (87.6 vs 82.9) or the number of children with FEV(1) less than 80%.
Conclusions:
Age at the time of lobectomy did not influence FVC or FEV(1). These preliminary data suggest that early lobectomy does not confer an advantage to the child with respect to long-term pulmonary function. A prospective study is necessary to confirm or refute these findings in a larger group of children.
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