Jessica Kapralik1, Carolyn Wayne1, Emily Chan1, Ahmed Nasr2. 1. Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada, K1H 8 L1. 2. 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.
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.
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: Jennifer Pogoriler; Daniel Swarr; Portia Kreiger; N Scott Adzick; William Peranteau Journal: Am J Surg Pathol Date: 2019-01 Impact factor: 6.394
Authors: Cynthia D Downard; Casey M Calkins; Regan F Williams; Elizabeth J Renaud; Tim Jancelewicz; Julia Grabowski; Roshni Dasgupta; Milissa McKee; Robert Baird; Mary T Austin; Meghan A Arnold; Adam B Goldin; Julia Shelton; Saleem Islam Journal: Pediatr Surg Int Date: 2017-06-06 Impact factor: 1.827
Authors: Daniel T Swarr; William H Peranteau; Jennifer Pogoriler; David B Frank; N Scott Adzick; Holly L Hedrick; Mike Morley; Su Zhou; Edward E Morrisey Journal: Am J Respir Crit Care Med Date: 2018-05-15 Impact factor: 30.528