Elective thoracoscopic surgery for congenital lung malformations: what age to operate?

Abstract

Purpose: This study aimed to evaluate the characteristics of congenital lung malformations (CLMs) in patients from infancy to adulthood, and to determine the optimal timing for thoracoscopic surgery.

Methods: All patients with CLMs who underwent thoracoscopic surgery between 2017 and 2023 were retrospectively reviewed. The patients were divided into five age groups: 1-6 months, 6-12 months, 1-4 years, 4-16 years, and >16 years. Clinical characteristics and surgical outcomes were compared and analyzed for variance among the age groups.

Results: A total of 173 patients with CLM were included. Thirteen (7.5%) patients were categorized in the 1-6 months age group, 44 (25.4%) in the 6-12 months age group, 58 (33.5%) in the 1-4 years age group, 30 (17.3%) in the 4-16 years age group, and 28 (16.2%) in the > 16 years age group. The median age at surgery was 2.3 years (range: 1 month to 74 years). The operative time was shortest in the 1-4 years age group at 86.5 min (interquartile range: 57.3-131.5 min, p < 0.01). The results of the multivariate regression analysis indicated that age > 4 years (odds ratio [OR]: 8.70, p < 0.01) and previous infection (OR: 3.75, p < 0.01) increased the risk of operative adhesions, which increased the risk of major complications and conversion to open thoracotomy.

Conclusion: Thoracoscopic surgery for CLMs is safe and feasible at all ages. Age < 4 years may predict uneventful surgical outcomes due to fewer operative adhesions.