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Thoracoscopic versus open lobectomy in infants with congenital lung malformations: A multi-institutional propensity

Jennine H Weller1, Shawn D St Peter2, Mary E Fallat3

  • 1Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, Baltimore, MD, United States.

Journal of Pediatric Surgery
|May 25, 2021
PubMed

Insights

Thoracoscopic lobectomy for asymptomatic congenital lung malformations in infants is as safe as open surgery. This minimally invasive approach is now preferred, showing similar postoperative outcomes.

Area of Science:

  • Pediatric Surgery
  • Thoracic Surgery
  • Congenital Malformations

Background:

  • Congenital lung malformations (CLM) are common birth defects.
  • The optimal surgical approach for asymptomatic CLM in infants is debated.
  • Thoracoscopic surgery is increasingly used, but its outcomes compared to open surgery require clarification.

Purpose of the Study:

  • To evaluate the effect of operative approach on perioperative outcomes in infants undergoing lobectomy for asymptomatic CLM.
  • To compare thoracoscopic versus open lobectomy in this pediatric population.
  • To determine if thoracoscopic surgery is non-inferior to open surgery for CLM resection.

Main Methods:

  • Retrospective cohort study of 506 children with CLM resected across 11 centers over 7 years.
  • Identified 175 infants undergoing elective lobectomy, balancing covariates using propensity scores.
  • Analyzed outcomes based on intention to treat using weighted conditional regression.

Main Results:

  • Thoracoscopic lobectomy had significantly longer operative times (26 min) but used less epidural anesthesia compared to open lobectomy.
  • No significant differences were observed in intraoperative blood loss, postoperative complications, chest tube duration, or length of hospital stay.
  • Thoracoscopy was the most common approach (50.9%), followed by open (38.3%) and converted thoracoscopic (10.9%) procedures.

Conclusions:

  • Thoracoscopic lobectomy is a safe and effective alternative to open surgery for asymptomatic CLMs in infants.
  • The non-inferiority in postoperative outcomes supports the continued use of thoracoscopy.
  • Minimally invasive thoracoscopic surgery is becoming the standard of care for these conditions.
Abstract

Keywords:
Bronchopulmonary sequestrationCongenital lobar emphysemaCongenital lung malformationsCongenital pulmonary airway malformationPropensity scoreThoracoscopy

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