title: Surgical versus conservative management of congenital pulmonary airway malformation in children: A systematic review and meta-analysis.
abstract: BACKGROUND
  The ideal management of infants born with asymptomatic congenital pulmonary airway malformation (CPAM) is controversial. We performed a systematic review and meta-analysis comparing elective resection versus expectant management.
  
  
  METHODS
  We searched CENTRAL, MEDLINE, EMBASE, CINAHL, and PubMed for studies describing the management of asymptomatic CPAM and reporting on postoperative morbidity, mortality, and length of hospital stay (LOS). We performed meta-analyses when possible and provide a narrative summary of results.
  
  
  RESULTS
  One nonrandomized prospective and eight retrospective studies met our inclusion criteria. Out of 168 patients, 70 underwent surgery before symptoms developed with seven experiencing postoperative complications (10.0%); 63 developed symptoms while being managed expectantly and subsequently underwent surgery with 20 complications (31.8%). Thirty-five patients continued to be followed nonsurgically (three months to nine years of follow-up). Morbidity was higher with surgery after symptom development (6 studies; odds ratio 4.59, 95% confidence interval (CI) 1.40 to 15.11, P<0.01); there was no difference in LOS (3 studies; mean difference 4.96, 95% CI -1.75 to 11.67, P=0.15). There were no related deaths.
  
  
  CONCLUSIONS
  Elective resection of asymptomatic CPAM lesions is safe and prevents the risk of symptom development, which may result in a more complicated surgery and recovery.
authors.affiliation: Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada, K1H 8 L1.
authors.forename: Jessica
authors.initials: J
authors.lastname: Kapralik
authors.affiliation: Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada, K1H 8 L1.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Wayne
authors.affiliation: Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada, K1H 8 L1.
authors.forename: Emily
authors.initials: E
authors.lastname: Chan
authors.affiliation: Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada, K1H 8 L1; Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada, K1H 8 M5. Electronic address: anasr@cheo.on.ca.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Nasr
mesh_terms: D058070:Asymptomatic Diseases; D002648:Child; D002675:Child, Preschool; D015615:Cystic Adenomatoid Malformation of Lung, Congenital / Q000601:surgery* / Q000628:therapy; D017558:Elective Surgical Procedures; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D011183:Postoperative Complications; D016896:Treatment Outcome
keywords: Asymptomatic; Congenital cystic adenomatoid malformation; Congenital cystic lung malformation; Congenital pulmonary airway malformation; Surgery