Perinatal management of congenital cystic lung lesions in the age of minimally invasive surgery

• Published in: Journal of pediatric surgery Vol. 41; no. 5; pp. 893 - 896
• Main Authors: Truitt, Anne K., Carr, Stephen R., Cassese, John, Kurkchubasche, Arlet G., Tracy, Thomas F., Luks, Francois I.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2006
• Subjects: Cystic Adenomatoid Malformation of Lung, Congenital - surgery; Humans; Infant; Laparoscopy; Thoracoscopy; Congenital lung lesions; Fetus; Laparoscopy; CCAM; Thoracoscopy
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2006.01.004

Most congenital cystic lung lesions (CCLLs) do not require in utero or perinatal intervention. The management of asymptomatic lesions is controversial: the theoretical risk of infection and malignancy is offset by whether thoracotomy in asymptomatic children is justified. We examined our recent experience and the role of minimally invasive surgery.
We analyzed the pre-, peri-, and postnatal findings of all consecutive CCLLs diagnosed between 1997 and 2005. We reviewed records for pre-, and postnatal imaging, management, and outcome.
Thirty-five CCLL were diagnosed prenatally. Since 2000, all asymptomatic lesions were removed endoscopically at 6 to 18 months (thoracoscopy for 6 extralobar sequestrations, 3 intralobar sequestrations/congenital cystic adenomatoid malformations, 5 bronchogenic cysts, and retroperitoneal laparoscopy for 2 intraabdominal sequestrations). Congenital cystic adenomatoid malformation elements were present in more than 70%. Two abdominal lesions have regressed, and 2 patients are awaiting intervention. One symptomatic infant underwent thoracotomy for congenital lobar emphysema.
It has been argued that the risks associated with congenital lung lesions (infection and malignancy) justify intervention in the asymptomatic patient. In our experience, all these lesions could be safely removed using endosurgical techniques. Counseling of (future) parents should be updated to include minimally invasive surgery in the management algorithm.