Should asymptomatic congenital cystic adenomatous malformations be removed? the case against

In this article, we debate the pros and cons for the surgical removal of asymptomatic antenatally diagnosed cystic adenomatous malformations (CCAM). It is often argued that asymptomatic antenatally diagnosed CCAMs should be surgically removed in infancy due to the risk of future malignancy, future risk of infection and other symptoms and of increased risk of surgery after infective episodes. However, the risk of malignancy is often overplayed and the risk may not even be decreased after excision of the CCAM. Furthermore, the risk of future symptoms is uncertain thus surgical removal will subject many infants to unnecessary risk. Medical follow up will decrease the numbers that undergo surgical intervention and newer imaging techniques are likely to decrease the radiation risk. Whichever route of management is followed there is an urgent need to outline the natural history of asymptomatic CCAMs.