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Predictive Factors and Outcomes of Successful Thoracoscopic Lung Resection in Pediatric Patients.

Research paper by Rachael A RA Clark, Eduardo A EA Perez, Dai H DH Chung, Samir R SR Pandya

Indexed on: 30 Dec '20Published on: 29 Dec '20Published in: Journal of The American College of Surgeons



Abstract

Less than 50% of children with congenital lung lesions are treated thoracoscopically. There is variable data regarding the benefits and limited information on factors contributing to successful thoracoscopic lobectomies in pediatric patients. We sought to identify predictive factors leading to safe and efficient thoracoscopic lung resections. A single-center, retrospective chart review of patients (<18 yrs) who underwent lung resection between June 2009 to July 2020 was performed. Pulmonary wedge resections were excluded. Data collected included demographics, perioperative findings, such as symptoms or infections, and post-operative outcomes. Univariate, multivariate and sensitivity analyses were performed. Ninety-six patients were identified. Sixty-nine patients (72%) underwent initial thoracoscopy with 15 (22%) converting to open thoracotomy (CTO). Forty-one (43%) patients had preoperative symptoms and 15 (15.6%) had an active infection. Among symptomatic patients, 18 (43.9%) underwent thoracotomy and 23 (56%) were attempted thoracoscopically-of which 13 (31%) were completed thoracoscopically. On univariate analysis age>1, infection, preoperative symptoms and intraoperative adhesions were associated with CTO. Older age (OR = 1.041) and EBL (OR = 2.398) were significant prognostic factors of CTO on logistic regression. Thoracoscopy was significantly associated with decreased length of stay, opioid use, chest tube duration, blood loss and need for blood transfusion. There was no difference in operative time, 30-day readmission or mortality. Thoracoscopy has become a standard approach for pediatric lung resections. Our findings indicate that age < 1 and the absence of active respiratory infections and preoperative symptoms may be predictive of successful completion of the thoracoscopic approach. Thoracoscopy offers significant advantages over the traditional open thoracotomy with regards to blood loss and opioid requirements, LOS and chest tube duration. Copyright © 2020. Published by Elsevier Inc.