Pulmonary function after early vs late lobectomy during childhood: a preliminary study

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.