Asymptomatic congenital cystic adenomatoid malformation of the lung: Is it time to operate?

Conforti, Andrea; Aloi, Ivan; Trucchi, Alessandro; Morini, Francesco; Nahom, Antonella; Inserra, Alessandro; Bagolan, Pietro

doi:10.1016/j.jtcvs.2009.01.014

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 4 , Pages 826-830, October 2009

Asymptomatic congenital cystic adenomatoid malformation of the lung: Is it time to operate?

Andrea Conforti, MD
- Department of Medical and Surgical Neonatology, Unit of Newborn Surgery, “Bambino Gesu” Children's Hospital, Rome, Italy
- Address for reprints: Andrea Conforti, MD, Department of Medical and Surgical Neonatology, “Bambino Gesu” Children's Hospital, Rome, Italy.
Ivan Aloi, MD
- Department of Surgery, Unit of Pediatric General Surgery, “Bambino Gesu” Children's Hospital, Rome, Italy
Alessandro Trucchi, MD
- Department of Medical and Surgical Neonatology, Unit of Newborn Surgery, “Bambino Gesu” Children's Hospital, Rome, Italy
Francesco Morini, MD
- Department of Medical and Surgical Neonatology, Unit of Newborn Surgery, “Bambino Gesu” Children's Hospital, Rome, Italy
Antonella Nahom, MD
- Department of Medical and Surgical Neonatology, Unit of Newborn Surgery, “Bambino Gesu” Children's Hospital, Rome, Italy
Alessandro Inserra, MD
- Department of Surgery, Unit of Pediatric General Surgery, “Bambino Gesu” Children's Hospital, Rome, Italy
Pietro Bagolan, MD
- Department of Medical and Surgical Neonatology, Unit of Newborn Surgery, “Bambino Gesu” Children's Hospital, Rome, Italy

Received 8 January 2008; received in revised form 17 December 2008; accepted 27 January 2009. published online 27 March 2009.

Objective

The optimal management of congenital adenomatoid malformation of the lung remains controversial. Prenatal ultrasonographic analysis has increasingly discovered asymptomatic lesions, raising questions about the need for and timing of surgical treatment for asymptomatic congenital adenomatoid malformation. The aim of our study was to analyze the short-term postoperative outcome of symptomatic congenital adenomatoid malformations compared with asymptomatic malformations.

Methods

All the data of patients presenting with congenital adenomatoid malformations histologically diagnosed and operated on between 1998 and 2005 at our institution were retrospectively reviewed. Patients were divided into 2 groups: group A comprised asymptomatic infants, and group B comprised symptomatic infants. Major outcomes considered were the length of ventilation, pleural drainage, and hospital stay. Postoperative morbidity and mortality were also evaluated. Asymptomatic patients were further stratified for age at the time of the operation to evaluate whether age at surgical intervention affects the outcome. The Fisher's exact and Mann–Whitney tests were used as appropriate.

Results

Fifty-seven patients were consecutively treated. Thirty-five patients were given diagnoses of asymptomatic lesions and were enrolled into group A, whereas 22 patients presenting with symptoms were entered into group B. The lengths of ventilation, pleural drainage, and hospital stay were significantly longer in patients with symptomatic congenital adenomatoid malformations. Moreover, symptomatic patients presented with a higher postoperative complication rate. The age-based stratification of asymptomatic children did not show any difference on either postoperative mortality or major outcome considered.

Conclusion

Children with congenital adenomatoid malformations operated on when asymptomatic present a better short-term outcome than symptomatic children. In addition, age at the time of the operation does not negatively affect the outcome. Our findings support early surgical treatment for asymptomatic congenital adenomatoid malformation.

Abbreviations and Acronyms: CCAM, congenital cystic adenomatoid malformation of the lung, CI, confidence interval, OR, odds ratio

CTSNet classification: 11