title: Morbidity after elective resection of prenatally diagnosed asymptomatic congenital pulmonary airway malformations.
abstract: OBJECTIVE
  The optimal management of prenatally diagnosed asymptomatic congenital pulmonary airway malformations (CPAM) is controversial. Since there is a paucity of data relating to surgical risks in this specific population, we reviewed our experience to further inform this controversy.
  
  
  METHODS
  Ethically approved 10 year (2004-2013) retrospective review. Patients were included only if the CPAM was diagnosed prenatally and remained asymptomatic. Indication for surgery was physician recommendation and/or parental choice.
  
  
  RESULTS
  Sixty patients were identified. Median age at surgery was 6.5 months (range 65 days to 9.6 years). Resections were performed thoracoscopically (n = 51, one conversion) or by thoracotomy (n = 9). Surgical time was 2.5 hr (43 min to 4.75 hr). A chest drain was used in 58/60 and remained in situ 53 hr (23-108). There were no intra-operative complications or blood transfusions. All patients were extubated at the end of the procedure with no re-intubations. Post-operative hospitalization was 73.4 hr (23.8 hr to 4.2 days). Overall, complications occurred in 14/60 (23%). Eleven were minor but three were major: tension pneumothorax associated with new presentation of a small previously undiagnosed diaphragmatic hernia 5 days following resection; aggressive fibromatosis of the chest wall in the region close to resection 2 years later; and near-fatal hypovolemic cardiac arrest due to massive haemorrhage from a feeding vessel on postoperative day 7. There were no deaths and no cases of pleuropulmonary blastoma.
  
  
  CONCLUSIONS
  Resection of prenatally diagnosed asymptomatic CPAM is associated with a significant risk of complications, which may be life threatening. These data contribute to a balanced discussion of risks and benefits for these children.
authors.affiliation: Department of Surgery, University of Toronto and Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Canada.|Faculty of Medicine, University of Southampton, Southampton, UK.
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Hall
authors.affiliation: Department of Surgery, University of Toronto and Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Canada.
authors.forename: Priscilla P L
authors.initials: PP
authors.lastname: Chiu
authors.affiliation: Department of Surgery, University of Toronto and Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Canada.
authors.forename: Jacob C
authors.initials: JC
authors.lastname: Langer
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008168:Lung / Q000002:abnormalities* / Q000601:surgery; D008297:Male; D011030:Pneumothorax / Q000209:etiology; D011296:Prenatal Diagnosis; D015619:Respiratory System Abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000009:adverse effects*; D013908:Thoracotomy / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: bronchopulmonary sequestration; congenital cystic adenomatoid malformation; congenital malformations; lobectomy; pleuropulmonary blastoma; prenatal diagnosis