Clinical Outcomes of Total Peri-Adventitial Cystectomy Compared to Conventional Techniques in Pediatric Pulmonary...

Pediatric pulmonary cystic echinococcosis (PCE) frequently necessitates surgical intervention, but the optimal surgical technique remains a subject of debate. Total peri-adventitial cystectomy (TPAC) is a radical surgical approach with potential benefits, but its use is restricted by technical challenges and concerns about complications. This single-center retrospective cohort study aimed to assess the clinical effectiveness of TPAC compared to conventional surgical techniques in managing pediatric PCE.

A retrospective cohort study included 135 pediatric patients (aged ≤16 years) diagnosed with PCE and treated at the First Affiliated Hospital of Xinjiang Medical University between January 2017 and December 2022. Patients were divided into four groups based on the surgical technique: TPAC with capitonnage (Group A), cystostomy with capitonnage (Group B), aspiration-cystotomy and capitonnage (Figuera technique, Group C), and pulmonary wedge resection (Group D).

The Group A had a significantly shorter chest tube placement duration, median 5 days (interquartile range [IQR] 4-7), compared to Group B (7 days, IQR 6-8) and Group C (7 days, IQR 5-9) (P = 0.006, P = 0.003, respectively). Additionally, Group A was linked to a shorter hospital stay, median 7 days (IQR 5-8), compared to Group C, which median 8 days (IQR 6-10) (P = 0.019). The incidence of pneumothorax was notably lower in Group A (2.9 %) than in Group C (24.4 %; P = 0.010). No significant differences were found in operative time, intraoperative blood loss, 24-h chest tube drainage volume, duration of ICU stay, or in the incidence of bronchopleural fistula, prolonged air leakage, empyema, atelectasis, pleural effusion, residual cavity, residual cavity infection, or surgical wound infection among the groups (P > 0.05). One recurrence was reported in Group C during the follow-up period.

Compared to conventional surgical methods, TPAC offers several benefits, including faster postoperative recovery and a lower incidence of pneumothorax, without increasing the risk of postoperative complications. These results highlight TPAC as a safe and effective surgical option for pediatric PCE, with the potential to enhance clinical outcomes and lower recurrence rates.

Level Ⅲ.