title: Does thoracoscopy have advantages over open surgery for asymptomatic congenital lung malformations? An analysis of 1626 resections.
abstract: OBJECTIVE
  The apparent incidence of antenatally diagnosed congenital lung malformations (CLM) is rising (1 in 3000), and the majority undergo elective resection even if asymptomatic. Thoracoscopy has been popularized, but early series report high conversion rates and significant complications. We aimed to perform systematic review/meta-analysis of outcomes of thoracoscopic vs open excision of asymptomatic CLMs.
  
  
  METHODS
  A systematic review according to PRISMA guidelines was performed. Data were extracted for all relevant studies (2004-2015) and Rangel quality scores calculated. Analysis was on 'intention to treat' basis for thoracoscopy and asymptomatic lung lesions. Meta-analysis was performed using the addon package METAN of the statistical package STATA14™; p<0.05 was considered significant.
  
  
  RESULTS
  36 studies were eligible, describing 1626 CLM resections (904 thoracoscopic, 722 open). There were no randomized controlled trials. Median quality score was 14/45 (IQR 6.5) 'poor'. 92/904 (10%) thoracoscopic procedures were converted to open. No deaths were reported. Meta-analysis showed that regarding thoracoscopic procedures, the total number of complications was significantly less (OR 0.63, 95% CI 0.43, 0.92; p<0.02, 12 eligible series, 912 patients, 404 thoracoscopic). Length of stay was 1.4days shorter (95%CI 2.40, 0.37;p<0.01). Length of operation was 37 min longer (95% CI 18.96, 54.99; p<0.01). Age, weight, and number of chest tube days were similar. There was heterogeneity (I230%, p=0.15) and no publication bias seen.
  
  
  CONCLUSIONS
  A reduced total complication rate favors thoracoscopic excision over thoracotomy for asymptomatic antenatally diagnosed CLMs. Although operative time was longer, and open conversion may be anticipated in 1/10, the overall length of hospital stay was reduced by more than 1day.
  
  
  METHODS
  4 (based on lowest level of article analyzed in meta-analysis/systematic review).
authors.affiliation: Department of Paediatric Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Adams
authors.affiliation: Department of Paediatric Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Jobson
authors.affiliation: Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, Hampshire, UK.
authors.forename: Patarawan
authors.initials: P
authors.lastname: Sangnawakij
authors.affiliation: Department of Paediatric Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Heetun
authors.affiliation: Department of Paediatric Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Thaventhiran
authors.affiliation: Department of Paediatric Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK.
authors.forename: Navroop
authors.initials: N
authors.lastname: Johal
authors.affiliation: Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, Hampshire, UK.
authors.forename: Dankmar
authors.initials: D
authors.lastname: Böhning
authors.affiliation: Department of Paediatric Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK. Electronic address: Michael.stanton@uhs.nhs.uk.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Stanton
mesh_terms: D058070:Asymptomatic Diseases; D015615:Cystic Adenomatoid Malformation of Lung, Congenital / Q000175:diagnosis / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011013:Pneumonectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D011296:Prenatal Diagnosis; D013906:Thoracoscopy; D013908:Thoracotomy; D016896:Treatment Outcome
keywords: Congenital cystic adenomatoid malformation; Congenital lung lesion; Meta-analysis; Surgery thoracoscopic