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Treatment strategies for pulmonary sequestration in childhood: resection, embolization, observation?
Stephen C Brown1, Mark De Laat, Marijka Proesmans
1Pediatric and Congenital Cardiology, University Hospitals Leuven, Belgium.
Insights
Pulmonary sequestration treatment in children can be surgery or embolization, with both showing effective and safe outcomes. Presenting symptoms guide the choice: surgery for infection, embolization to abolish shunts.
Area of Science:
- Pediatric Surgery
- Interventional Pulmonology
- Thoracic Surgery
Background:
- The optimal management strategy for pediatric pulmonary sequestration, including resection versus embolization, lacks clear definition.
- This study addresses the absence of a defined institutional policy by analyzing outcomes of both surgical and embolization therapies.
Purpose of the Study:
- To evaluate and compare the local management strategies for pediatric pulmonary sequestration.
- To determine the effectiveness and safety of surgical resection and embolization in children with pulmonary sequestration.
Main Methods:
- A retrospective, single-institutional review of 48 pediatric patients diagnosed with pulmonary sequestration.
- Patients were categorized into three groups: conservative management (n=5), surgical resection (n=22), and embolization (n=21).
- Data collected included age at treatment, presenting symptoms, complications, and follow-up outcomes.
Main Results:
- Median age at treatment was similar between surgical (8.0 months) and embolization (4.0 months) groups.
- Recurrent chest infections were primary in the surgical group, while cardiac failure predominated in the embolization group (P < 0.01).
- Complication rates were comparable (6 in surgery vs. 1 in embolization), with good overall outcomes in both treatment arms.
Conclusions:
- Both surgical resection and endovascular embolization are safe and effective treatments for pulmonary sequestration in children.
- Therapeutic decisions should be guided by presenting symptoms: surgery for infection, embolization for shunt abolition.
- The study did not lead to a change in the institution's management policy.
Background:
The ideal treatment strategy for pulmonary sequestration whether resection or embolization in childhood is not clearly defined. Our institution has no clear policy, therefore both therapies are performed.
Objective:
The aim of this study was to assess local management strategies of children presenting with pulmonary sequestrations.
Methods:
This is a retrospective, single-institutional review. The main inclusion criterion was the established diagnosis of a pulmonary sequestration. Forty-eight patients were divided into three groups based on treatment received: conservative management (n = 5), surgery (n = 22) and embolization (n = 21).
Results:
The median age at treatment was 8.0 months (range 1.2- 166.0) in the surgical, 4.0 months (range 0.2 - 166.0) in the embolization and 8 months (range 0.3 - 197.0) in the conservatively managed groups, respectively. Age at treatment was similar in the surgical and embolization groups (P = 0.9). Recurrent chest infections were the most common clinical presentation in the surgical group, whilst cardiac failure was the most frequent symptom in the embolization group (P < 0.01; 95% CI: 0.3 to 0.9). There were six complications in the surgical group and one in the embolization group (P = 0.1). In one patient embolization was not possible. Outcomes in both groups were comparable with good results on follow-up.
Conclusion:
Both surgery and endovascular embolization are effective and safe treatments for pulmonary sequestration. The presenting symptoms dictate therapy: surgery if there is infection and embolization if a shunt needs to be abolished. Our institutional policy remains unchanged.
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