Does thoracoscopy have advantages over open surgery for asymptomatic congenital lung malformations? An analysis of 1626 resections

Stephen Adams; Matthew Jobson; Patarawan Sangnawakij; Adam Heetun; Anthony Thaventhiran; Navroop Johal; Dankmar Böhning; Michael P Stanton

doi:10.1016/j.jpedsurg.2016.11.014

Does thoracoscopy have advantages over open surgery for asymptomatic congenital lung malformations? An analysis of 1626 resections

J Pediatr Surg. 2017 Feb;52(2):247-251. doi: 10.1016/j.jpedsurg.2016.11.014. Epub 2016 Nov 13.

Authors

Stephen Adams¹, Matthew Jobson¹, Patarawan Sangnawakij², Adam Heetun¹, Anthony Thaventhiran¹, Navroop Johal¹, Dankmar Böhning², Michael P Stanton³

Affiliations

¹ Department of Paediatric Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK.
² Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, Hampshire, UK.
³ Department of Paediatric Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK. Electronic address: Michael.stanton@uhs.nhs.uk.

PMID: 27889066
DOI: 10.1016/j.jpedsurg.2016.11.014

Abstract

Aim: The apparent incidence of antenatally diagnosed congenital lung malformations (CLM) is rising (1 in 3000), and the majority undergo elective resection even if asymptomatic. Thoracoscopy has been popularized, but early series report high conversion rates and significant complications. We aimed to perform systematic review/meta-analysis of outcomes of thoracoscopic vs open excision of asymptomatic CLMs.

Methods: A systematic review according to PRISMA guidelines was performed. Data were extracted for all relevant studies (2004-2015) and Rangel quality scores calculated. Analysis was on 'intention to treat' basis for thoracoscopy and asymptomatic lung lesions. Meta-analysis was performed using the addon package METAN of the statistical package STATA14™; p<0.05 was considered significant.

Results: 36 studies were eligible, describing 1626 CLM resections (904 thoracoscopic, 722 open). There were no randomized controlled trials. Median quality score was 14/45 (IQR 6.5) 'poor'. 92/904 (10%) thoracoscopic procedures were converted to open. No deaths were reported. Meta-analysis showed that regarding thoracoscopic procedures, the total number of complications was significantly less (OR 0.63, 95% CI 0.43, 0.92; p<0.02, 12 eligible series, 912 patients, 404 thoracoscopic). Length of stay was 1.4days shorter (95%CI 2.40, 0.37;p<0.01). Length of operation was 37 min longer (95% CI 18.96, 54.99; p<0.01). Age, weight, and number of chest tube days were similar. There was heterogeneity (I² 30%, p=0.15) and no publication bias seen.

Conclusions: A reduced total complication rate favors thoracoscopic excision over thoracotomy for asymptomatic antenatally diagnosed CLMs. Although operative time was longer, and open conversion may be anticipated in 1/10, the overall length of hospital stay was reduced by more than 1day.

Level of evidence: 4 (based on lowest level of article analyzed in meta-analysis/systematic review).

Keywords: Congenital cystic adenomatoid malformation; Congenital lung lesion; Meta-analysis; Surgery thoracoscopic.

Publication types

Comparative Study
Meta-Analysis
Review
Systematic Review

MeSH terms

Asymptomatic Diseases*
Cystic Adenomatoid Malformation of Lung, Congenital / diagnosis
Cystic Adenomatoid Malformation of Lung, Congenital / surgery*
Elective Surgical Procedures / methods
Female
Humans
Infant, Newborn
Pneumonectomy / methods*
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Pregnancy
Prenatal Diagnosis
Thoracoscopy*
Thoracotomy*
Treatment Outcome