Outcomes after postnatal resection of prenatally diagnosed asymptomatic cystic lung lesions.
BACKGROUND
Symptomatic congenital lung lesions require surgical resection, but the management of asymptomatic lung lesions is controversial. Some surgeons advocate observation because of concerns about potential operative morbidity and mortality, as well as a lack of long-term follow-up information. On the other hand, malignant degeneration, pneumonia, and pneumothorax are known consequences of cystic lung lesions. This study aims to assess the safety of resection for asymptomatic lung lesions that were diagnosed before birth.


METHODS
A retrospective review of all patients with prenatally diagnosed lung lesions at Children's Hospital of Philadelphia (Philadelphia, Penn) was performed from 1996 to 2005. The perioperative course of patients who were asymptomatic was analyzed.


RESULTS
One hundred five complete records of children with asymptomatic lesions were reviewed. Overall mortality was 0% and morbidity was 6.7% including 2.9% significant postoperative air leak and 3.8% transfusion requirement. Nine patients had a pathologic diagnosis that differed from preoperative radiological findings, and 9 patients had additional pathologic findings.


CONCLUSIONS
This series demonstrates that surgery can be performed safely on patients who were asymptomatic with congenital cystic adenomatoid malformation of the lung and other types of lung lesions with no mortality and minimal morbidity. The frequency of disparate pathologic diagnoses and the potential for development of malignancy and other complications support the argument for early resection.
Tsai
Anthony Y
AY
The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Liechty
Kenneth W
KW
Hedrick
Holly L
HL
Bebbington
Michael
M
Wilson
R Douglas
RD
Johnson
Mark P
MP
Howell
Lori J
LJ
Flake
Alan W
AW
Adzick
N Scott
NS
D015615:Cystic Adenomatoid Malformation of Lung, Congenital / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006776:Hospitals, Pediatric; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D011013:Pneumonectomy / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods*; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome