title: Bronchogenic cyst: best time for surgery?
abstract: BACKGROUND
  Bronchogenic cyst (BC) is a benign congenital mediastinal tumor whose natural course remains unclear. In adults, most BCs are removed by thoracotomy after complications. Currently, prenatal diagnosis is generally feasible and allows an early thoracoscopic intervention. The purpose of this retrospective study was to ascertain the best time for the operation.
  
  
  METHODS
  Reviewed were 36 patients (11 children, 25 adults) with a BC managed from 2000 to 2011. Clinical history, cyst size, duration of hospitalization, preoperative and postoperative complications, and detection of inflammatory elements were compared (Student t tests) between pediatric and adult patients.
  
  
  RESULTS
  In the pediatric group, diagnosis was made prenatally in 7 patients, during the neonatal period in 2, and later in 2. Nine were asymptomatic. In the adult group, 20 patients were treated for complications. Thoracotomy was performed in 2 children and thoracoscopy in 9 (no conversion). A thoracoscopic operation was performed in 9 adults (2 conversions), and 17 adults required additional procedures (4 pericardial and 9 lung resections, 3 bronchial, and 1 esophageal sutures). The average length of hospitalization was 4.45 days for children (3.33 days in the thoracoscopic subgroup) and 8 days for adults. Mean maximal cyst diameter was 2.2 cm in children and 6.5 cm in adults (p < 0.10). Pathologic study revealed inflammatory reaction in 2 children (18%) vs 21 adults (84%; p < 0.001).
  
  
  CONCLUSIONS
  Early surgical resection of BCs provides better conservation of pulmonary parenchyma, a lower incidence of inflammatory lesions, and a reduced rate of complications, and should be proposed after prenatal diagnosis, between the 6th and 12th month of life.
authors.affiliation: Department of Pediatric Surgery, Hôpital Timone Enfant, Aix-Marseille University and Assistance Publique-Hôpitaux de Marseille, Marseille, France.
authors.forename: Lucile
authors.initials: L
authors.lastname: Fievet
authors.forename: Xavier Benoit
authors.initials: XB
authors.lastname: D'Journo
authors.forename: Jean Michel
authors.initials: JM
authors.lastname: Guys
authors.forename: Pascal A
authors.initials: PA
authors.lastname: Thomas
authors.forename: Pascal
authors.initials: P
authors.lastname: De Lagausie
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001994:Bronchogenic Cyst / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult