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Lobectomy versus lung-sparing resection for congenital pulmonary airway malformation (CPAM): a single-center
Irene Paraboschi1,2, Ugo Maria Pierucci3, Carlotta Ardenghi3
1Department of Biomedical and Clinical Science, University of Milano, Milan, Italy. irene.paraboschi@unimi.it.
Insights
Lobectomy offers better disease control for congenital pulmonary airway malformation (CPAM) in children, significantly reducing the need for repeat surgeries compared to lung-sparing procedures.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Congenital Lung Abnormalities
Background:
- Congenital pulmonary airway malformation (CPAM) is a rare congenital lung lesion in children.
- Surgical management aims for complete resection and optimal long-term outcomes.
- Debate exists regarding the superiority of lobectomy versus lung-sparing techniques.
Purpose of the Study:
- To compare perioperative and long-term outcomes of lobectomy and lung-sparing resections for pediatric CPAM.
- To evaluate the efficacy and safety of different surgical approaches.
- To identify the most reliable surgical option for CPAM management in children.
Main Methods:
- Retrospective single-center study of children with CPAM (2005-2024).
- Comparison of perioperative variables, postoperative outcomes, redo surgery rates, and chest wall anomalies.
- Statistical analysis using Mann-Whitney U test and Fisher's exact test.
Main Results:
- Lobectomy had longer operative (207 vs. 149 min) and anesthesia times (371 vs. 230 min).
- Redo surgery was significantly lower after lobectomy (0% vs. 33%, p=0.0207).
- Postoperative complications and chest wall deformities were less frequent after lobectomy, though not statistically significant.
Conclusions:
- Lobectomy provides more definitive disease control for CPAM in children.
- Lung-sparing resections are associated with a higher rate of redo surgery.
- Lobectomy is the most reliable surgical option for CPAM; lung-sparing approaches require careful patient selection.
Aim:
To compare perioperative and long-term outcomes of lobectomy versus lung-sparing resection in children undergoing surgery for congenital pulmonary airway malformation (CPAM).
Methods:
A retrospective single-center study was conducted including children who underwent primary surgical resection for postnatally confirmed CPAM between 2005 and 2024. Patients with other congenital lung lesions, bilateral disease, syndromic conditions, or incomplete data were excluded. Perioperative variables, postoperative outcomes, redo surgery, and chest wall anomalies were compared between lobectomy and lung-sparing resections. Continuous variables were analyzed using the Mann-Whitney U test and categorical variables using Fisher's exact test.
Results:
Thirty-one children were included (22 lobectomies, 9 lung-sparing resections), with a median age at surgery of 8 months. Operative time (207 vs. 149 min, p = 0.0425) and anesthesia time (371 vs. 230 min, p = 0.0171) were significantly longer for lobectomy. Intraoperative complications occurred in 10% of patients, with no significant difference between groups. Postoperative complications were less frequent after lobectomy (19% vs. 44%), although not statistically significant (p = 0.1954). Redo surgery was required exclusively after lung-sparing resections (33% vs. 0%, p = 0.0207). Length of hospital stay and NICU/PICU stay were comparable. At a median follow-up of 71 months, chest wall deformities were observed less often after lobectomy (22% vs. 43%, p = 0.3554).
Conclusions:
Despite longer operative and anesthesia times, lobectomy provided more definitive disease control, with a significantly lower need for redo surgery compared with lung-sparing resection. Lobectomy remains the most reliable surgical option for CPAM in children, while lung-sparing approaches should be reserved for carefully selected cases.
