Minimal Invasive Lung Sparing Resections in Children below One Year of Age

Congenital Lung Malformations (CLM) antenatally detected bear a risk of developing infections or pneumothorax during infancy and possible late malignancies. For these reasons most authors recommend resection during the 1st year of life. Lung-sparing segmentectomies have raised interest to avoid resecting normal pulmonary tissue when performing lobectomies. We review our experience with Minimal Invasive Lung-Sparing Resection (MILSR) below one year of age. All patients <1y with antenatally diagnosed CLM, confirmed postnatally by 1 or 2 CT-scans, who underwent MILSR from 2007 to 2014 were reviewed. 18 patients ranging 4 to 12 mo (mean 7 mo) including 15 segmentectomies and 3 bisegmentectomies for 12 cystic congenital adenomatoid malformations (CCAM) or 4 intralobar sequestrations (ILSP) and 2 bronchial atresia. 8 segmentectomies were completed strictly thoracoscopically, 7 were done by thoracoscopy with a mini thoracotomy to end the dissection and extract large specimens. No conversion was done for bleeding. Chest drain was left in place for a mean duration of 2.1 d. Complications were one subcutaneous emphysema without consequence and one persistent asymptomatic pneumothorax after drain removal that resolved spontaneously. In 12/18 cases the malformation was confirmed at pathology, but its nature or grade was different of what was suspected in 6 cases: all 4 ILSP were correctly diagnosed; in 3 cases of CCAM the grade was different; 2 cases preoperatively described as bronchial atresia were CCAM, one of them including a bronchogenist cyst; one presumed CCAM was a bronchogenist cyst. Mean follow-up was 39 mo (9 to 72 mo). All patients remain asymptomatic, with symmetrical appearance of the 2 lungs. None of the imaging performed at a mean delay of 11 mo has shown a remaining lesion. As CLM are more frequently detected due to antenatal imaging improvements, we are facing more asymptomatic cases. MILSR performed during the 1st year of life is a good and safe option to relieve the risk they bear and avoid recurrent irradiations related to radiologic observation.