Elective thoracoscopic surgery for congenital lung malformations: what age to operate?

This study aimed to evaluate the characteristics of congenital lung malformations (CLMs) in patients from infancy to adulthood, and to determine the optimal timing for thoracoscopic surgery.

All patients with CLMs who underwent thoracoscopic surgery between 2017 and 2023 were retrospectively reviewed. The patients were divided into five age groups: 1-6 months, 6-12 months, 1-4 years, 4-16 years, and >16 years. Clinical characteristics and surgical outcomes were compared and analyzed for variance among the age groups.

A total of 173 patients with CLM were included. Thirteen (7.5%) patients were categorized in the 1-6 months age group, 44 (25.4%) in the 6-12 months age group, 58 (33.5%) in the 1-4 years age group, 30 (17.3%) in the 4-16 years age group, and 28 (16.2%) in the > 16 years age group. The median age at surgery was 2.3 years (range: 1 month to 74 years). The operative time was shortest in the 1-4 years age group at 86.5 min (interquartile range: 57.3-131.5 min, p < 0.01). The results of the multivariate regression analysis indicated that age > 4 years (odds ratio [OR]: 8.70, p < 0.01) and previous infection (OR: 3.75, p < 0.01) increased the risk of operative adhesions, which increased the risk of major complications and conversion to open thoracotomy.

Thoracoscopic surgery for CLMs is safe and feasible at all ages. Age < 4 years may predict uneventful surgical outcomes due to fewer operative adhesions.