Morbidity after thoracoscopic resection of congenital pulmonary airway malformations (CPAM): single center experience over a decade

Purpose Video-assisted thoracoscopic (VATS) resection of CPAM in children is an established, albeit controversial strategy for its management. We report a 10-year single center experience. Methods All children underwent VATS (2008–2017) and their current status was reviewed. Patients were grouped: ‘symptomatic-P’ (if parents reported recurrent lower respiratory tract infections etc.) or ‘symptomatic-S’ (neonates presenting with respiratory distress/difficulty) or ‘asymptomatic’. Results 73 children, aged 10 m (4d–14yrs) underwent VATS; a neonate as an emergency (‘symptomatic-S’) and all others electively. The lesion was unilateral in all but one case. Histologically none were malignant. Of the elective 72 cases, 7 (10%) required conversion to open thoracotomy. Twenty (27.7%) were ‘symptomatic-P’ and the duration of surgery when compared to ‘asymptomatic’ children was longer 269 (range 129–689) versus 178 (range 69–575) minutes ( P = 0.01). Post operatively, 8 children (11%) had a grade III/IV (Clavien–Dindo) complication; persistent air leak/pneumothorax ( n = 5), chylothorax ( n = 1), pleural effusion ( n = 1) and seizure/middle cerebral artery thrombosis ( n = 1). There was no mortality. Twenty-four children (33.3%) were reported ‘symptomatic-P’ post-surgery after a median follow up of 2.18 years. The surgical intervention had no impact on ‘symptomatic-P’ status ( P = 0.46). Conclusion The risks of surgery may outweigh benefit in asymptomatic children. ClinicalTrials.gov Identifier NCT04449614.