https://doi.org/10.4081/pmc.2024.337
Morbidity related to major lung thoracoscopic resections in children
Submitted: 21 March 2024
Accepted: 21 May 2024
Published: 18 October 2024
Accepted: 21 May 2024
Abstract Views: 8
PDF: 10
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
In pediatric thoracic surgery, reported predictors for increased risk are symptoms and active/previous infections (RAP). We investigated the adverse events related to Video-Assisted Thoracic Surgery (VATS) in pediatric patients when considering RAP predictors. A retrospective analysis of pediatric VATS major lung resections in 2008-2021 was conducted at three institutions. We employed the pediatric surgical risk calculator to define patients’ preoperative predicted risk (PredR). Postoperative complications were classified according to the Thoracic Morbidity & Mortality (TM&M) system. The observed TM&M rate (ObsR) and the PredR were compared. A subgroup analysis by RAP predictors was conducted. 37 patients (54% female) were included. Mean age and weight were 5.8 years and 22.8 kg. 56.7% had respiratory symptoms, 38.9% active infection and 59.5% history of infections (RAP subpopulations). VATS procedures were lobectomy (n=32), segmentectomy (n=3), bilobectomy (n=1) and pneumonectomy (n=1). The conversion rate was 5.4%. The mean PredR was of 4.43% (±1.8) and the overall ObsR was 45.94% with a median severity of II (I-III). This difference was significant and a higher PredR was not associated with complications development. PredR does not show association among the RAP vs non-RAP group. ObsR showed positive association with RAP, even if it reached statistical significance only for “respiratory symptoms” risk factor. ObsR reflected the number of bronchiectasis patients in our series (n=9), aligning with the hypothesis of “earlier and safer surgery”. The risk calculator underestimates VATS morbidity. Multicentre studies will clarify the correlation between inflammation and surgical adverse events.
1. Kantor N, Wayne C, Nasr A. Symptom development in originally asymptomatic CPAM diagnosed prenatally: a systematic review. Ped Sur Int 2018;34:613-620.
DOI: https://doi.org/10.1007/s00383-018-4264-y
2. Wong KKY, Flake AW, Tibboel D, et al. Congenital pulmonary airway malformation: advances and controversies. Lancet Child Adolesc Health 2018;2:290-7.
DOI: https://doi.org/10.1016/S2352-4642(18)30035-X
3. Kunisaki SM, Saito JM, Fallat ME, et al. Development of a multi-institutional registry for children with operative congenital lung malformations. J Ped Sur 2020;55:1313-8.
DOI: https://doi.org/10.1016/j.jpedsurg.2019.01.058
4. Cook J, Chitty LS, De Coppi P, et al. The natural history of prenatally diagnosed congenital cystic lung lesions: long-term follow-up of 119 cases. Arch Dis Child 2017;102:798-803.
DOI: https://doi.org/10.1136/archdischild-2016-311233
5. Downard CD, Calkins CM, Williams RF, et al. Treatment of congenital pulmonary airway malformations: a systematic review from the APSA outcomes and evidence based practice committee. Ped Surg Int 2017;33:939-53.
DOI: https://doi.org/10.1007/s00383-017-4098-z
6. Hall NJ, Stanton MP. Long-term outcomes of congenital lung malformations. Semin Pediatr Surg 2017;26:311-6.
DOI: https://doi.org/10.1053/j.sempedsurg.2017.09.001
7. Kapralik J, Wayne C, Chan E, et al. Surgical versus conservative management of congenital pulmonary airway malformation in children: A systematic review and meta-analysis. J Pediatr Surg 2016;51:508-12.
DOI: https://doi.org/10.1016/j.jpedsurg.2015.11.022
8. Kunisaki SM. Narrative review of congenital lung lesions. Transl Pediatr 2021;10:1418-31.
DOI: https://doi.org/10.21037/tp-20-133
9. Bonnard A. Thoracoscopic lobectomy for congenital pulmonary airway malformation: where are we in 2019? Eur J Pediatr Surg 2020;30:146-9.
DOI: https://doi.org/10.1055/s-0040-1702221
10. Annunziata F, Bush A, Borgia F, et al. Congenital lung malformations: unresolved issues and unanswered questions. Front Pediatr 2019;7:239.
DOI: https://doi.org/10.3389/fped.2019.00239
11. Jelin EB, O'Hare EM, Jancelewicz T, et al. Optimal timing for elective resection of asymptomatic congenital pulmonary airway malformations. J Pediatr Surg 2018;53:1001-5.
DOI: https://doi.org/10.1016/j.jpedsurg.2018.02.032
12. Ng C, Stanwell J, Burge DM, Stanton MP. Conservative management of antenatally diagnosed cystic lung malformations. Arch Dis Child 2014;99:432-7.
DOI: https://doi.org/10.1136/archdischild-2013-304048
13. Naito Y, Beres A, Lapidus-Krol E, et al. Does earlier lobectomy result in better long-term pulmonary function in children with congenital lung anomalies? A prospective study. J Pediatr Surg 2012;47:852-6.
DOI: https://doi.org/10.1016/j.jpedsurg.2012.01.037
14. Patrizi S, Pederiva F, d'Adamo AP. Whole-Genome Methylation Study of Congenital Lung Malformations in Children. Front Oncol 2021;11:689833.
DOI: https://doi.org/10.3389/fonc.2021.689833
15. Casagrande A, Pederiva F. Association between congenital lung malformations and lung tumors in children and adults: a systematic review. J Thorac Oncol 2016;11:1837-45.
DOI: https://doi.org/10.1016/j.jtho.2016.06.023
16. Clark RA, Perez EA, Chung DH, et al. Predictive factors and outcomes for successful thoracoscopic lung resection in pediatric patients. J Am Coll Surg 2021;232:551-8.
DOI: https://doi.org/10.1016/j.jamcollsurg.2020.12.013
17. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 1992;111:518-26.
18. Seely AJ, Ivanovic J, Threader J, et al. Systematic classification of morbidity and mortality after thoracic surgery. Ann Thorac Surg 2010;90:936-42; discussion 942.
DOI: https://doi.org/10.1016/j.athoracsur.2010.05.014
19. Ivanovic J, Al-Hussaini A, Al-Shehab D, et al. Evaluating the reliability and reproducibility of the Ottawa Thoracic Morbidity and Mortality classification system. Ann Thorac Surg 2011;91:387-93.
20. Ivanovic J, Al-Hussaini A, Al-Shehab D, et al. Evaluating the reliability and reproducibility of the Ottawa Thoracic Morbidity and Mortality classification system. Ann Thorac Surg 2011;91:387-93.
DOI: https://doi.org/10.1016/j.athoracsur.2010.10.035
21. Salati M, Refai M, Pompili C, et al. Major morbidity after lung resection: a comparison between the European Society of Thoracic Surgeons Database system and the Thoracic Morbidity and Mortality system. J Thorac Dis 2013;5:217-22.
22. Ivanovic J, Seely AJ, Anstee C, et al. Measuring surgical quality: comparison of postoperative adverse events with the american college of surgeons NSQIP and the Thoracic Morbidity and Mortality classification system. J Am Coll Surg 2014;218:1024-31.
DOI: https://doi.org/10.1016/j.jamcollsurg.2013.12.043
23. Akbilgic O, Langham MR Jr, Walter AI, et al. A novel risk classification system for 30-day mortality in children undergoing surgery. PLoS One 2018;13:e0191176.
DOI: https://doi.org/10.1371/journal.pone.0191176
24. Bruny JL, Hall BL, Barnhart DC, et al. American College of Surgeons National Surgical Quality Improvement Program Pediatric: a beta phase report. J Pediatr Surg 2013;48:74-80.
DOI: https://doi.org/10.1016/j.jpedsurg.2012.10.019
25. Kraemer K, Cohen ME, Liu Y, et al. Development and Evaluation of the American College of Surgeons NSQIP Pediatric Surgical Risk Calculator. J Am Coll Surg 2016;223:685-93.
DOI: https://doi.org/10.1016/j.jamcollsurg.2016.08.542
26. Stey AM, Kenney BD, Moss RL, et al. A risk calculator predicting postoperative adverse events in neonates undergoing major abdominal or thoracic surgery. J Pediatr Surg 2015;50:987-91.
DOI: https://doi.org/10.1016/j.jpedsurg.2015.03.023
27. EUROCAT. Prevalence tables. 1996-2019. Accessed: July 2022. Available from: https://eu-rd-platform.jrc.ec.europa.eu/eurocat/eurocat-data/prevalence_en
28. Ugolini S, Coletta R, Lo Piccolo R, et al. Uniportal video-assisted thoracic surgery in a pediatric hospital: early results and review of the literature. J Laparoendosc Adv Surg Tech A 2022;32:713-20.
DOI: https://doi.org/10.1089/lap.2021.0180
29. ESTS. Database Annual Report 2020. Available from: https://www.ests.org/_userfiles/pages/files/Silver_Book2020_Part1_2_Short_300920OK.pdf
30. Sandri A, Papagiannopoulos K, Milton R, et al. Major morbidity after video-assisted thoracic surgery lung resections: a comparison between the European Society of Thoracic Surgeons definition and the Thoracic Morbidity and Mortality system. J Thorac Dis 2015;7:1174-80.
31. Andalib A, Ramana-Kumar AV, Bartlett G, et al. Influence of postoperative infectious complications on long-term survival of lung cancer patients: a population-based cohort study. J Thorac Oncol 2013;8:554-61.
DOI: https://doi.org/10.1097/JTO.0b013e3182862e7e
How to Cite
Ugolini, S., Tofani, L., Zolpi, E., Montalva, L., Lotti, C., Morabito, A., … Bonnard, A. (2024). Morbidity related to major lung thoracoscopic resections in children. La Pediatria Medica E Chirurgica, 46(2). https://doi.org/10.4081/pmc.2024.337
Copyright (c) 2024 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- The Editors, 52nd National Congress of the Italian Society of Paediatric Surgery | Ancona, 20-22 October 2022 , La Pediatria Medica e Chirurgica: Vol. 45 No. 1 (2023)
- Silvia Richetta, Antonio Andreacchio, Sergio Monforte, Percutaneous Achilles tenotomy using a 18 gauge needle in the treatment of clubfoot with Ponseti method , La Pediatria Medica e Chirurgica: Vol. 44 No. s1 (2022)
- Arie Kusumaningrum, Yeni Rustina, Tomy Abuzairi, Nurhadi Ibrahim, Nurdina Widanti, Gita Rindang Lestari, Analysis of the infant’s acute pain assessment using developed conductance skin electric instrument compared to the behavioural and faces pain scale in painful injected vaccine , La Pediatria Medica e Chirurgica: Vol. 45 No. s1 (2023)
- Rose Nirwana Handayani, Defi Efendi, The impact of multiple insertions on peripheral intravenous access in low-birth-weight infants in perinatology , La Pediatria Medica e Chirurgica: Vol. 43 No. s1 (2021)
- Silvia Pierantoni, Marco Corradin, Roberto Schiavon, Valentina Luppi, Andrea Micaglio, Acquired genu recurvatum in a skeletally immature patient treated by physeal distraction: A case report , La Pediatria Medica e Chirurgica: Vol. 44 No. s1 (2022)
- Alessandra Merenda, Francesco Falciglia, Cristian Aletto, Angelo Gabriele Aulisa, Renato Maria Toniolo, Management of slipped capital femoral epiphysis: What hardware we can use in osteosynthesis in situ? , La Pediatria Medica e Chirurgica: Vol. 44 No. s1 (2022)
- Paolo Trezza, Francesco Uboldi, Antonio Memeo, ACL lesions surgical treatment in pediatric patients. Our all-epiphyseal experience , La Pediatria Medica e Chirurgica: Vol. 44 No. s1 (2022)
You may also start an advanced similarity search for this article.