Pulmonary function in children after lobectomy

Studies in children evaluating the long term impact of lobectomy on pulmonary function are rare. The aim of the study was to evaluate lung function parameters in children, several years after lobectomy. A retrospective study was conducted in 3 Belgian university hospitals, on children under the age of 16 years who underwent lobectomy between 1996 and 2016. Demographic data, associated anomalies, lobectomy indication, surgical procedure, complications and pulmonary function tests were extracted from patient files and analyzed. Hundred-eight patients were included. The most common indication for lobectomy was a congenital lung lesion (41%). Seventy-seven patients performed postoperative pulmonary function tests at different time intervals (mean 5.2 yrs post-surgery; range 2 months -15 yrs). TLC, FVC, FEV1 and FEV1/FVC were within limits of normal for 84%, 74%, 72% and 68% of the population respectively. Almost two thirds of the study population had maximal expiratory flows (MEF) at 25%, 50%, 75% and 25%-75% below 80% predicted. Fifty percent of patients had a residual volume (RV) above 120% predicted. Pulmonary function parameters were not significantly different between children who had surgery below versus above the age of 1 and 2 years. There was no short or long term mortality from the lobectomy. Twenty-six patients had a minor complication, the most common being pneumothorax, and two patients had a major complication. In conclusion, the majority of the study population had normal TLC, FEV1 and FVC post lobectomy, however decreased MEF values and increased RV suggest an increased incidence of small airway obstruction. Larger prospective studies are needed to confirm and explain these findings.