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Predictive Factors and Outcomes for Successful Thoracoscopic Lung Resection in Pediatric Patients
Rachael A Clark1, Eduardo A Perez2, Dai H Chung1
1Department of Surgery, Division of Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Insights
Pediatric thoracoscopic lung resection is effective, offering reduced blood loss and opioid use. Younger age (<1 year) and absence of symptoms/infection predict successful thoracoscopic procedures, avoiding open conversion.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Minimally Invasive Surgery
Background:
- Congenital lung lesions in children are often treated with open thoracotomy, with less than 50% undergoing thoracoscopic procedures.
- Limited data exists on factors influencing successful thoracoscopic lobectomies in pediatric patients.
Purpose of the Study:
- To identify predictive factors for safe and efficient thoracoscopic lung resection in pediatric patients.
- To compare outcomes between thoracoscopic and open thoracotomy approaches.
Main Methods:
- Retrospective chart review of pediatric patients (<18 years) undergoing lung resection (excluding wedge resection) from June 2009 to July 2020.
- Data included demographics, perioperative findings (symptoms, infection), and postoperative outcomes.
- Univariate, multivariate, and sensitivity analyses were performed to identify predictive factors for conversion to open thoracotomy (CTO).
Main Results:
- Ninety-six patients were analyzed; 72% initially underwent thoracoscopy, with 22% converting to open thoracotomy (CTO).
- Preoperative symptoms (43%) and active infection (15.6%) were common. Age >1 year, infection, symptoms, and adhesions predicted CTO on univariate analysis.
- Older age and estimated blood loss (EBL) were significant predictors of CTO. Thoracoscopy significantly reduced length of stay (LOS), opioid use, chest tube duration, blood loss, and transfusion needs.
Conclusions:
- Thoracoscopy is a standard approach for pediatric lung resection, offering significant benefits over open thoracotomy.
- Factors predicting successful thoracoscopic completion include younger age (<1 year) and absence of preoperative respiratory infection and symptoms.
- Thoracoscopic approach is associated with decreased blood loss, opioid requirements, LOS, and chest tube duration.
Background:
Less than 50% of children with congenital lung lesions are treated thoracoscopically. There are variable data regarding the benefits and limited information on factors contributing to successful thoracoscopic lobectomies in pediatric patients. We sought to identify predictive factors leading to safe and efficient thoracoscopic lung resection.
Study Design:
We performed a single-center, retrospective chart review of patients (age <18 y) who underwent lung resection between June 2009 and July 2020. Pulmonary wedge resection was excluded. Data collected included demographics, perioperative findings, such as symptoms or infection, and postoperative outcomes. Univariate, multivariate, and sensitivity analyses were performed.
Results:
Ninety-six patients were identified. Sixty-nine patients (72%) underwent initial thoracoscopy, with 15 (22%) converting to open thoracotomy (CTO). Forty-one (43%) patients had preoperative symptoms and 15 (15.6%) had an active infection. Among symptomatic patients, 18 (43.9%) underwent thoracotomy and 23 (56%) were attempted thoracoscopically, 13 (31%) of whom were completed thoracoscopically. On univariate analysis, age >1 year, infection, preoperative symptoms, and intraoperative adhesions were associated with CTO. Older age (odds ratio [OR] = 1.041) and estimated blood loss (EBL) (OR = 2.398) were significant prognostic factors of CTO on logistic regression. Thoracoscopy was significantly associated with decreased length of stay, opioid use, chest tube duration, blood loss and need for blood transfusion. There was no difference in operative time, 30-day readmission, or mortality.
Conclusions:
Thoracoscopy has become a standard approach for pediatric lung resection. Our findings indicate that age < 1 year and the absence of active respiratory infection and preoperative symptoms may be predictive of successful completion of the thoracoscopic approach. Thoracoscopy offers significant advantages over the traditional open thoracotomy with regard to blood loss and opioid requirements, LOS, and chest tube duration.
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