E.E. West1,2, U.M. Patwardhan1,2, G. Gollin1 1Rady Children’s Hospital, Pediatric Surgery, San Diego, CA, USA 2Naval Medical Center, General Surgery, San Diego, CA, USA
Introduction: Congenital cystic lung lesions are associated with a risk of infection or malignancy and are typically managed with resection of the affected lobe. In single- and multicenter studies, thoracoscopic lobectomy is safe and associated with a shorter length of stay (LOS) and fewer complications than open lobectomy. Since these data may not reflect overall national outcomes that include both high and low-volume surgeons and sites, we sought to document trends in the utilization of thoracoscopic and open lobectomy for cystic lung lesions at US children’s hospitals and evaluate outcomes.
Methods: The Pediatric Health Information System (PHIS) database was queried for all patients diagnosed with congenital cystic lung lesions between 2010 and 2023. To exclude urgent lobectomies for symptomatic lesions and delayed diagnoses more likely to be associated with inflammation, patients who underwent lobectomy prior to 30 days of age or diagnosed after one year of age were excluded. Outcomes assessed included LOS narcotic use, and postoperative complications.
Results: After exclusion, 2100 patient records were reviewed. Over the 14 years evaluated, the annual number of open lobectomies remained constant while thoracoscopic lobectomies doubled. The proportion of lobectomies accomplished thoracoscopically increased from 40% to 72% (60%, overall). Patients who underwent open or thoracoscopic lobectomy did not differ in terms of sex, gestational age, or birthweight, but open lobectomy patients were younger (Table). The overall incidence of complications was greater for the open approach, but this difference was mainly driven by more frequent transfusions (2.1% vs 0.6%, p = .003) and respiratory failure (1.6% vs 0.7%, p =.05). The incidence of air leak (1.9% vs 1.5%, p = .52), bleeding (0.5% vs 0.2%, p = .37), infection (0.5% vs 0.2%, p=.37), need for additional procedures (2.0% vs 1.6%, p = .31), and death (0.1% vs 0.1%, p=.78) did not differ based on approach. However, open lobectomy was associated with longer LOS (Table). Conversion from a thoracoscopic to open operation occurred in 2.8% of cases.
Conclusion: We found that most lobectomies for congenital cystic lung lesions in US children’s hospitals are currently accomplished thoracoscopically and this approach is being used increasingly relative to open lobectomy. Thoracoscopic lobectomy was associated with decreased LOS and less frequent transfusion and respiratory failure, although this may be due to selection biases that were not apparent in PHIS and the younger age of that cohort. Reoperation and air leak were unusual for both approaches. These data validate the safety and efficacy of thoracoscopic lobectomy as it is broadly applied in US children’s hospitals.