Systematic review and meta-analysis of the postnatal management of congenital cystic lung lesions.
BACKGROUND
Antenatally detected asymptomatic congenital cystic lung lesions may be managed conservatively or by surgical resection. We undertook a systematic review and meta-analysis to quantify the risks of elective surgery, emergency surgery, and observation.


METHODS
All series published between 1996 and 2008, where the postnatal management of congenital cystic lung lesions was described, were reviewed. A meta-analysis was performed to determine whether elective or emergency surgery was associated with a higher risk of adverse outcomes.


RESULTS
There were 41 reports describing 1070 patients (of whom 79% were antenatally detected). Five hundred five neonates survived without surgery into infancy, of whom only 16 (3.2%) became symptomatic. For all ages, elective surgery was associated with significantly less complications than emergency surgery. The risk ratio was 2.8 (95% confidence interval, 1.4-5.5; P < .005) when comparing complications after elective surgery with emergency surgery.


CONCLUSIONS
The risk of asymptomatic cases developing symptoms is small. However, elective surgery is associated with a better outcome than emergency surgery. If elective surgery is undertaken, it should be performed before 10 months. Although no prognostic indicators have so far been identified in the literature, a conservative approach may be appropriate for small lesions.
King's College Hospital, Paediatric Surgery, Denmark Hill, London, United Kingdom.
Michael
M
Stanton
Ike
I
Njere
Niyi
N
Ade-Ajayi
Shailesh
S
Patel
Mark
M
Davenport
D000028:Abortion, Induced / Q000706:statistics & numerical data; D001998:Bronchopulmonary Sequestration / Q000175:diagnosis / Q000601:surgery*; D015615:Cystic Adenomatoid Malformation of Lung, Congenital / Q000175:diagnosis / Q000601:surgery*; D017558:Elective Surgical Procedures; D004630:Emergencies; D005260:Female; D005313:Fetal Death / Q000453:epidemiology / Q000209:etiology; D005315:Fetal Diseases / Q000175:diagnosis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000706:statistics & numerical data; D016896:Treatment Outcome