Short-term outcomes of thoracoscopic versus open lobectomy for congenital lung malformations,Pediatric Surgery International

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Short-term outcomes of thoracoscopic versus open lobectomy for congenital lung malformations
Pediatric Surgery International ( IF 1.5 ) Pub Date : 2023-03-22 , DOI: 10.1007/s00383-023-05445-7
Steven L Raymond ₁ , Marla A Sacks ₁ , Asra Hashmi ₂ , Jason O Robertson ₃ , Donald Moores ₁ , Edward P Tagge ₁ , Andrei Radulescu ₁ , Saleem Islam ₄ , Faraz A Khan ₁

Affiliation

Purpose

Thoracoscopic and open approaches for the management of congenital lung malformations (CLM) has been debated. The aim of this study is to compare 30-day outcomes for non-emergent lobectomies in children.

Methods

The National Surgical Quality Improvement Program-Pediatric database was queried for patients undergoing CLM resection from 2013 to 2020. Outcomes were compared by operative technique in an intention-to-treat model and then propensity matched.

Results

2157 patients met inclusion criteria and underwent non-emergent pulmonary lobectomy for CLM. The intended operative approach was thoracoscopic in 57.7% of patients. Patients in the open group compared to the thoracoscopic were more likely to be born premature, have chronic lung disease, require preoperative oxygen support, and be ventilator dependent. After propensity matching, there was no statistically significant difference in 30-day mortality, unplanned readmission, and other complications between the thoracoscopic and open groups. Thoracoscopic approach was associated with a shorter length of stay. The proportion of cases approached via thoracoscopy increased over time from 48.8% in 2013 to 69.9% in 2020.

Conclusions

This large multicenter retrospective matched analysis demonstrates thoracoscopic lobectomy in children has similar favorable 30-day outcomes and shorter length of stay for the non-emergent management of CLM, compared to open thoracotomy.

Level of evidence

Level III.

中文翻译：

胸腔镜与开腹肺叶切除术治疗先天性肺畸形的短期结果

目的

胸腔镜和开放手术治疗先天性肺畸形（CLM）一直存在争议。本研究的目的是比较儿童非紧急肺叶切除术的 30 天结果。

方法

查询了国家外科质量改进计划-儿科数据库中 2013 年至 2020 年接受 CLM 切除的患者。在意向治疗模型中通过手术技术比较结果，然后进行倾向匹配。

结果

2157 名患者符合纳入标准并接受了非紧急肺叶切除术治疗 CLM。 57.7% 的患者计划采用胸腔镜手术。与胸腔镜组的患者相比，开腹组的患者更有可能早产、患有慢性肺部疾病、需要术前氧气支持并且依赖呼吸机。倾向匹配后，胸腔镜组和开腹组的30天死亡率、非计划再入院和其他并发症没有统计学差异。胸腔镜入路与较短的住院时间相关。随着时间的推移，通过胸腔镜检查的病例比例从 2013 年的 48.8% 增加到 2020 年的 69.9%。