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01-06-2017 | Review Article

Optimal age for elective surgery of asymptomatic congenital pulmonary airway malformation: a meta-analysis

Authors: Katrina J. Sullivan, Michelle Li, Sarah Haworth, Elizabeth Chernetsova, Carolyn Wayne, Jessica Kapralik, Emily Chan, Ahmed Nasr

Published in: Pediatric Surgery International | Issue 6/2017

Abstract

Controversy exists on the optimal age for elective resection of asymptomatic congenital pulmonary airway malformation. Current recommendations vary widely, highlighting the overall lack of consensus. A systematic search of Embase, MEDLINE, CINAL, and CENTRAL was conducted in January 2016. Identified citations were screening independently in duplicate and consensus was required for inclusion. Results were pooled using inverse variance fixed effects meta-analysis. Meta-analysis results indicate no statistically significant differences for complications within the 3-month and 6-month age comparison groups [odds ratio (OR) 4.20, 95% confidence interval (CI) 0.78–22.77, I ² = 0%; OR 2.39, 95% CI 0.63–9.11, I ² = 0%, respectively]. Older patients were significantly favoured for 3-month and 6-month age comparison groups for length of hospital stay [mean difference (MD) 4.13, 95% CI 2.31–5.96, I ² = 0%; MD 3.38, 95% CI 0.44–6.31, I ² = 0%, respectively]. Borderline statistical significance was observed for chest tube duration in patients ≥6 months of age (MD 1.06, 95% CI 0.02–2.09, I ² = 0%). No mortalities were recorded. Surgical treatment appears to be safe at all ages, with no mortalities and similar rates of complications between age groups. The included evidence was not sufficient to make a conclusive recommendation on optimal age for elective resection.

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Waszak P, Claris O, Lapillonne A, Picaud JC, Basson E, Chappuis JP, Salle BL (1999) Cystic adenomatoid malformation of the lung: neonatal management of 21 cases. Pediatr Surg Int 15:326–331CrossRefPubMed

Laje P, Liechty KW (2008) Postnatal management and outcome of prenatally diagnosed lung lesions. Prenat Diagn 28:612–618CrossRefPubMed

Laberge JM, Puligandla P, Flageole H (2005) Asymptomatic congenital lung malformations. Semin Pediatr Surg 14:16–33CrossRefPubMed

Calvert JK, Lakhoo K (2007) Antenatally suspected congenital cystic adenomatoid malformations of the lung: postnatal investigation and timing of surgery. J Pediatr Surg 42:411–414CrossRefPubMed

Davenport M, Warne SA, Cacciaguerra S, Patel S, Greenough A, Nicolaides K (2004) Current outcome of antenatally diagnosed cystic lung disease. J Pediatr Surg 39:549–556CrossRefPubMed

Khosa JK, Leong SL, Borzi PA (2004) Congenital cystic adenomatoid malformation of the lung: indications and timing of surgery. Pediatr Surg Int 20:505–508CrossRefPubMed

Kim YT, Kim JS, Park JD, Kang CH, Kim JH (2005) Treatment of congenital cystic adenomatoid malformation - does resection in the early postnatal period increase surgical risk? Eur J Cardiothorac Surg 27:658–661CrossRefPubMed

Miller JA, Corteville JE, Langer JC (1996) Congenital cystic adenomatoid malformation in the fetus: natural history and predictors of outcome. J Pediatr Surg 31:805–808CrossRefPubMed

Sapin E, Lejeune V, Barbet JP, Carricaburu E, Lewin F, Baron JM, Barbotin-Larrieu F, Helardot PG (1997) Congenital adenomatoid disease of the lung: prenatal diagnosis and perinatal management. Pediatr Surg Int 12:126–129CrossRef

10.

Kapralik J, Wayne C, Chan E, Nasr A (2016) Surgical versus conservative management of congenital pulmonary airway malformation in children: a systematic review and meta-analysis 48. J Pediatr Surg 51:508–512CrossRefPubMed

11.

Khalek N, Johnson MP (2013) Management of prenatally diagnosed lung lesions. Semin Pediatr Surg 22:24–29CrossRefPubMed

12.

Liao SL, Lai SH, Hsueh C, Wong KS (2010) Comparing late-onset and neonatally-diagnosed congenital cystic adenomatoid malformations of the lung. Chang Gung Med J 33:36–43PubMed

13.

Chuang S, Sugo E, Jaffe A (2009) A review of postnatal management of congenital pulmonary airway malformations. Fetal Matern Med Rev 20:179–204CrossRef

14.

Thurlbeck WM (1982) Postnatal human lung growth. Throax 37:564–571CrossRef

15.

Zeltner TB, Caduff JH, Gehr P, Pfenninger J, Burri PH (1987) The postnatal development and growth of the human lung. I. Morphometry. Respir Physiol 67:247–268CrossRefPubMed

16.

Zeltner TB, Burri PH (1987) The postnatal development and growth of the human lung. II. Morphology. Respir Physiol 67:269–282CrossRefPubMed

17.

Joshi S, Kotecha S (2007) Lung growth and development. Early Hum Dev 83:789–794CrossRefPubMed

18.

Laberge JM, Bratu I, Flageole H (2004) The management of asymptomatic congenital lung malformations. Paediar Respir Rev 5(Suppl A):S305–S312

19.

Adzick NS (2003) Management of fetal lung lesions. Clin Perinatol 30:481–492CrossRefPubMed

20.

Frush DP, Donnelly LF, Rosen NS (2003) Computed tomography and radiation risk: what pediatric health care providers should know. Pediatrics 112:951–957CrossRefPubMed

21.

Eber E (2007) Antenatal diagnosis of congenital thoracic malformations: early surgery, late surgery or no surgery? Semin Respir Crit Care Med 28:355–366CrossRefPubMed

22.

PROSPERO: International prospective register of systematic reviews. University of York, centre for Reviews and Dissemination

23.

Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analysis: the PRISMA statement. Ann Intern Med 151:264–269CrossRefPubMed

24.

Linstone HA, Turoff M (1975) Delphi method: techniques and applications. Addison-Wesley Publishing, Boston, MA

25.

Canadian Association of Paediatric Surgeons Evidence-Based Resource. Canadian Association of Paediatric Surgeons

26.

Khangura S, Konnyu K, Cushman R, Grimshaw J, Moher D (2012) Evidence summaries: the evolution of a rapid review approach 17. Systematic Reviews 1:10CrossRefPubMedCentralPubMed

27.

Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (MINORS): development and validation of a new instrument 18. ANZ J Surg 73:712–716CrossRefPubMed

28.

The Nordic Cochrane Centre. Review Manager (RevMan). [5.3]. 2014. The Cochrane Collaboration. Ref Type: Computer Program

29.

Komori K, Kamagata S, Hirobe S, Toma M, Okumura K, Muto M, Kasai S, Hayashi A, Suenaga M, Miyakawa T (2009) Radionuclide imaging study of long-term pulmonary function after lobectomy in children with congenital cystic lung disease. J Pediatr Surg 44:2096–2100CrossRefPubMed

30.

Colon N, Schlegel C, Pietsch J, Chung DH, Purcell Jackson G (2012) Congenital lung anomalies: can we postpone resection? J Pediatr Surg 47:87–92CrossRefPubMed

31.

Keijzer R, Chiu PPL, Ratjen F, Langer JC (2009) Pulmonary function after early vs. late lobectomy during childhood: a preliminary study. J Pediatr Surg 44:893–895CrossRefPubMed

32.

Rothenberg S, Middlesworth W, Kadennhe-Chiweshe A, Aspelung G, Kuenzler K, Cowles R, Bodenstein L, Kay S, Shipman K, Rothenberg C, Stolar C, Stylianos S (2015) Two decades of experience with thoracoscopic lobectomy in infants and children: standardizing techniques for advanced thoracoscopic surgery. J Laparoendosc Adv Surg Tech 25:423–428CrossRef

33.

Rothenberg SS, Kuenzler KA, Middlesworth W, Kay S, Yoder S, Shipman K, Rodriguez R, Stolar CJ (2011) Thoracoscopic lobectomy in infants less than 10 kg with prenatally diagnosed cystic lung disease. J Laparoendosc Adv Surg Tech 21:181–184CrossRef

34.

Aspirot A, Puligandla PS, Bouchard S, Su W, Flageole H, Laberge JM (2008) A contemporary evaluation of surgical outcomes in neonates and infants undergoing lung resection. J Pediatr Surg 43:508–512CrossRefPubMed

35.

Aziz D, Langer JC, Tuuha SE, Ryan G, Ein SH, Kim PCW (2004) Perinatally diagnosed asymptomatic congenital cystic adenomatoid malformation: to resect or not? J Pediatr Surg 39:329–334CrossRefPubMed

36.

Boubnova J, Peycelon M, Garbi O, David M, Bonnard A (2011) Thoracoscopy in the management of congenital lung disease in infancy. Surg Endosc 25:593–596CrossRefPubMed

37.

Conforti A, Aloi I, Trucchi A, Morini F, Nahom A, Inserra A, Bagolan P (2009) Asymptomatic congenital cystic adenomatoid malformation of the lung: is it time to operate? J Thorac Cardiovasc Surg 138:826–830CrossRefPubMed

38.

Furukawa T, Kimura O, Sakai K, Higashi M, Fumino S, Aoi S, Tajiri T (2015) Surgical intervention strategies for pediatric congenital cystic lesions of the lungs: a 20-years single-institution experience. J Pediatr Surg 50:2025–2027CrossRefPubMed

39.

Naito Y, Beres A, Lapidus-Krol E, Ratjen F, Langer JC (2012) Does earlier lobectomy result in better long-term pulmonary function in children with congenital lung anomalies? A prospective study. J Pediatr Surg 47:852–856CrossRefPubMed

40.

Kongstad T, Buchvald F, Brenoe J, Petersen BL, Tabor A, Nielsen KG (2012) Radiology, histology and short-term outcome of asymptomatic congenital thoracic malformations. Acta Paediatr 101:155–158CrossRefPubMed

41.

Laje P, Pearson EG, Simpao AF, Rehman MA, Sinclair T, Hedrick HL, Adzick NS, Flake AW (2015) The first 100 infant thoracoscopic lobectomies: observations through the learning curve and comparison to open lobectomy. J Pediatr Surg 50:1811–1816CrossRefPubMed

42.

Chen HW, Hsu WM, Lu FL, Chen PC, Jeng SF, Peng SSF, Chen CY, Chou HC, Tsao PN, Hsieh Wu (2010) Management of congenital cystic adenomatoid malformation and bronchopulmonary sequestration in newborns. Pediatr Neonatol 51:172–177CrossRefPubMed

43.

Beres A, Aspirot A, Paris C, Berube D, Bouchard S, Laberge J-M, Lands LC, Puligandla P (2011) A contemporary evaluation of pulmonary function in children undergoing lung resection in infancy. J Pediatr Surg 46:829–832CrossRefPubMed

44.

Pelizzo G, Barbi E, Codrich D, Lembo MA, Zennaro F, Bussani R, Schleef J (2009) Chronic inflammation in congenital cystic adenomatoid malformations. An underestimated risk factor? J Pediatr Surg 44:616–619CrossRefPubMed

45.

Saeed A, Kazmierski M, Khan A, McShane D, Gomez A, Aslam A (2013) Congenital lung lesions: preoperative three-dimensional reconstructed CT scan as the definitive investigation and surgical management. Eur J Pediatr Surg 23:53–56CrossRefPubMed

46.

Ayed AK, Owayed A (2003) Pulmonary resection in infants for congenital pulmonary malformation. Chest 124:98–101CrossRefPubMed

47.

Van Schil PE, Hendriks JM, Lauwers P (2014) Focus on treatment complications and optimal management surgery. Translational Lung. Cancer Res 3:181–186

48.

Mueller MR, Marzluf BA (2014) The anticipation and management of air leaks and residual spaces post lung resection. J Thorac Dis 6:271–284PubMedCentralPubMed

49.

Pompili C, Miserocchi G (2016) Air leak after lung resection: pathophysiology and patients’ implications. J Thorac Dis 8:S46–S54PubMedCentralPubMed

50.

Chuang S, Sugo E, Jaffe A (2009) A review of postnatal management of congenital pulmonary airway malformation. Fetal Matern Med Rev 20:179–204CrossRef

51.

Azizkhan RG, Crombleholme TM (2008) Congenital cystic lung disease: contemporary antenatal and postnatal management. Pediatr Surg Int 24:643–657CrossRefPubMed

Title: Optimal age for elective surgery of asymptomatic congenital pulmonary airway malformation: a meta-analysis
Authors: Katrina J. Sullivan
Michelle Li
Sarah Haworth
Elizabeth Chernetsova
Carolyn Wayne
Jessica Kapralik
Emily Chan
Ahmed Nasr
Publication date: 01-06-2017
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Surgery International / Issue 6/2017
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-017-4079-2

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Optimal age for elective surgery of asymptomatic congenital pulmonary airway malformation: a meta-analysis

Abstract

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Abstract

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