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Does earlier lobectomy result in better long-term pulmonary function in children with congenital lung anomalies? A
Yoko Naito1, Alana Beres, Eveline Lapidus-Krol
1Division of Respirology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Insights
Early or late lobectomy for congenital pulmonary airway malformations does not impact future lung function. However, older age at surgery may be linked to slightly reduced maximal oxygen uptake (Vo2max).
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Pulmonary Medicine
Background:
- The optimal timing for surgical resection of asymptomatic congenital pulmonary airway malformations (CPAMs) is debated.
- Some advocate for neonatal resection, hypothesizing that earlier lobectomy promotes greater compensatory lung growth.
- This study investigates the relationship between age at lobectomy and long-term pulmonary outcomes.
Purpose of the Study:
- To determine if the age at which lobectomy is performed for CPAM correlates with future pulmonary function.
- To assess the impact of age at lobectomy on exercise testing parameters.
Main Methods:
- Retrospective review of patients who underwent lobectomy for CPAM between 1985 and 2002.
- Prospective pulmonary function testing (total lung capacity, forced vital capacity, forced expiratory volume in 1 second) and exercise testing (power, maximal oxygen uptake [Vo2max]) were performed.
- Correlation analysis between age at lobectomy and measured pulmonary and exercise parameters.
Main Results:
- No significant correlation was found between age at lobectomy and pulmonary function tests (total lung capacity, forced vital capacity, forced expiratory volume in 1 second).
- No correlation was observed between age at lobectomy and maximal work capacity (power).
- A trend suggested lower maximal oxygen uptake (Vo2max) in patients who underwent lobectomy at an older age (P = .055).
Conclusions:
- Most children achieve normal long-term pulmonary function after lobectomy for CPAM.
- The age at which lobectomy is performed does not appear to influence future pulmonary function.
- Cardiopulmonary exercise testing is recommended for a comprehensive evaluation of functional outcomes in these patients.
Background:
Management of asymptomatic congenital pulmonary airway malformations remains controversial when addressing the optimal timing of surgical resection. Neonatal resection is advocated by some based on the theory that earlier lobectomy results in greater compensatory lung growth. We examined whether age at lobectomy is correlated with better pulmonary outcomes as reflected by pulmonary function and exercise testing.
Methods:
Patients who had lobectomy for congenital pulmonary airway malformation between 1985 and 2002 were identified and underwent detailed clinical history, physical examination, pulmonary function testing (total lung capacity, forced vital capacity, forced expiratory volume in 1 second), and exercise testing (power, maximal oxygen uptake [Vo(2)max]).
Results:
Of 87 patients identified, 47 met the inclusion criteria, and 28 were tested prospectively. Age at the time of lobectomy ranged from 3 days to 56 months. There was no correlation between age at lobectomy and pulmonary function (total lung capacity, P = .408; forced vital capacity, P = .319; forced expiratory volume in 1 second, P = .174) or maximal work capacity (power, P = .280). There was a trend toward lower Vo(2)max in patients who had undergone lobectomy at an older age (Vo(2)max, P = .055).
Conclusion:
Most children undergoing lobectomy have normal long-term pulmonary function. We found no correlation between age at lobectomy and future pulmonary function. Cardiopulmonary exercise testing should be considered in evaluating functional outcome in these patients.
