title: Sparing-lung surgery for the treatment of congenital lung malformations.
abstract: OBJECTIVE
  Congenital lung malformations (CLM) are traditionally treated by pulmonary lobectomy. The foremost indication for surgery is that these lesions predispose to respiratory tract infections and to malignancy. Owing to the improvement of prenatal diagnosis, most patients are operated in a timely manner and prophylactically. In this context, lung-sparing surgery (LS) has gained interest as a lung preservation strategy, especially for asymptomatic patients. In the present study, we evaluated both thoracoscopic and open lung-preserving resections as an alternative to lobectomy for CLM resection.
  
  
  METHODS
  We retrospectively reviewed all patients who underwent lung-sparing resection (segmentectomy and atypical resection) for CLM from 2001 to 2010. Data were collected regarding preoperative diagnostic workup, type of intervention, and follow up.
  
  
  RESULTS
  Fifty-four patients received LS for CLM during the study period. Twenty-six were approached thoracoscopically, with 18 cases requiring open conversion for a complete resection. There were six postoperative complications: three asymptomatic pneumothoraces that resolved without intervention, one tension pneumothorax that required replacement of a drainage catheter, and three instances of intra-operative bleeding requiring blood transfusion. Mean duration of follow-up was 65.2 months. Two patients experienced pneumonia during the follow-up period. A third patient had a cystic lung lesion on postoperative computed tomography (CT) which required a second-look surgery.
  
  
  CONCLUSIONS
  LS for CLM is a safe and effective means of lung parenchymal preservation in pediatric patients. Complication rates are comparable to that of traditional lobectomy. In our experience, this type of lung surgery does not carry a higher risk of residual disease and recurrence if accurately planned in selected patients, i.e., those with small asymptomatic lesions. The complication rate is acceptable and apparently not affected by preoperative symptoms. The thoracoscopic approach is recommended, although open conversion should be advocated to avoid too long operative times.
authors.affiliation: Department of Paediatric Surgery, Paediatric Surgery Unit, University of Bologna, Via Massarenti, 11, 40138, Bologna, Italy. f.fascettileon@gmail.com
authors.forename: Francesco
authors.initials: F
authors.lastname: Fascetti-Leon
authors.forename: Dalia
authors.initials: D
authors.lastname: Gobbi
authors.forename: Stefania Valentina
authors.initials: SV
authors.lastname: Pavia
authors.forename: Antonio
authors.initials: A
authors.lastname: Aquino
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ruggeri
authors.forename: Giulio
authors.initials: G
authors.lastname: Gregori
authors.forename: Mario
authors.initials: M
authors.lastname: Lima
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008168:Lung / Q000002:abnormalities* / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D059351:Organ Sparing Treatments / Q000379:methods*; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies
keywords: CCAM; Congenital cystic lung; Segmental resection; Sparing-lung, wedge resection; Thoracoscopy