TY - JOUR
T1 - Thoracoscopic versus open lobectomy in infants with congenital lung malformations
T2 - A multi-institutional propensity score analysis
AU - Midwest Pediatric Surgery Consortium
AU - Weller, Jennine H.
AU - Peter, Shawn D.St
AU - Fallat, Mary E.
AU - Saito, Jacqueline M.
AU - Burns, Cartland R.
AU - Deans, Katherine J.
AU - Fraser, Jason D.
AU - Gadepalli, Samir K.
AU - Helmrath, Michael A.
AU - Hirschl, Ronald B.
AU - Kabre, Rashmi
AU - Lal, Dave R.
AU - Landman, Matthew P.
AU - Leys, Charles M.
AU - Mak, Grace Z.
AU - Minneci, Peter C.
AU - Wright, Tiffany N.
AU - Kunisaki, Shaun M.
N1 - Funding Information:
This project was supported by intramural funding from each institution within the Midwest Pediatric Surgery Consortium ( www.mwpsc.org ). No competing financial interests exist, and all authors have nothing to disclose.
Publisher Copyright:
© 2021
PY - 2021/12
Y1 - 2021/12
N2 - Purpose: The impact of thoracoscopic surgery on outcomes in children with congenital lung malformations (CLM) remains controversial. The purpose of this study was to determine the effect of operative approach on perioperative outcomes in infants undergoing lobectomy for an asymptomatic CLM. Methods: After IRB approval, a retrospective cohort study was conducted on 506 children with a CLM resected at one of eleven children's hospitals over a seven-year period. Infants undergoing elective lobectomy were identified, and covariates were balanced based on operative approach using propensity scores with full matching. Outcomes were analyzed based on intention to treat with weighted conditional regression. Results: One hundred seventy-five infants met inclusion criteria. There were 67 (38.3%) open, 89 (50.9%) thoracoscopic, and 19 (10.9%) thoracoscopic-converted-to-open lobectomies. Thoracoscopic lobectomy was associated with significantly longer operative times (26 min, 95% CI 6–47 min, p = 0.012) but used less epidural anesthesia (OR 0.02, 95% CI 0.004–0.11, p<0.001) when compared to open lobectomy. There were no significant differences in intraoperative blood loss, postoperative complications, chest tube duration, or length of stay. Conclusions: Thoracoscopy has become the most common operative approach for elective lobectomy in infants with asymptomatic CLMs. The non-inferiority of thoracoscopic lobectomy in postoperative outcomes supports its continued use as an alternative to open lobectomy.
AB - Purpose: The impact of thoracoscopic surgery on outcomes in children with congenital lung malformations (CLM) remains controversial. The purpose of this study was to determine the effect of operative approach on perioperative outcomes in infants undergoing lobectomy for an asymptomatic CLM. Methods: After IRB approval, a retrospective cohort study was conducted on 506 children with a CLM resected at one of eleven children's hospitals over a seven-year period. Infants undergoing elective lobectomy were identified, and covariates were balanced based on operative approach using propensity scores with full matching. Outcomes were analyzed based on intention to treat with weighted conditional regression. Results: One hundred seventy-five infants met inclusion criteria. There were 67 (38.3%) open, 89 (50.9%) thoracoscopic, and 19 (10.9%) thoracoscopic-converted-to-open lobectomies. Thoracoscopic lobectomy was associated with significantly longer operative times (26 min, 95% CI 6–47 min, p = 0.012) but used less epidural anesthesia (OR 0.02, 95% CI 0.004–0.11, p<0.001) when compared to open lobectomy. There were no significant differences in intraoperative blood loss, postoperative complications, chest tube duration, or length of stay. Conclusions: Thoracoscopy has become the most common operative approach for elective lobectomy in infants with asymptomatic CLMs. The non-inferiority of thoracoscopic lobectomy in postoperative outcomes supports its continued use as an alternative to open lobectomy.
KW - Bronchopulmonary sequestration
KW - Congenital lobar emphysema
KW - Congenital lung malformations
KW - Congenital pulmonary airway malformation
KW - Propensity score
KW - Thoracoscopy
UR - http://www.scopus.com/inward/record.url?scp=85106500478&partnerID=8YFLogxK
U2 - 10.1016/j.jpedsurg.2021.04.013
DO - 10.1016/j.jpedsurg.2021.04.013
M3 - Article
C2 - 34030879
AN - SCOPUS:85106500478
SN - 0022-3468
VL - 56
SP - 2148
EP - 2156
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
IS - 12
ER -