Short-term outcomes between small thoracotomy and thoracoscopic approach for pediatric lobectomy: A case control study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANG Lianyong , XIE Xiao , HU Fengqing , WANG Lei , HU Rui , XIAO Haibo ,  WANG Mingsong , LI Guoqing , DING Fangbao , MEI Ju

Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, P.R.China;

Corresponding author：

WANG Mingsong, Email: wms02100210@163.com

Keywords：

Minimally invasive; video-assisted thoracoscopic operation; lobectomy; children

DOI：

10.7507/1007-4848.201608087

Video：

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Objective To compare the short-term outcomes of small thoracotomy and thoracoscopic approach for pediatric lobectomy. Methods From June 2011 to June 2016, 42 patients with lung diseases undertook lobectomy in Xinhua Hospital. There were 24 males and 18 females with an average age of 7.13±5.00 years, ranging from 4 months to 16 years. According to different operation methods, they were divided into a thoracoscopy group (n=22) and a small incision group (n=20). Duration of operation, intraoperative blood loss, duration of postoperative drainage, and postoperative hospital stay and complications between the two groups were recorded and compared. Results There was no significant difference in the age, body weight between the two groups (8.44±4.99 yearsvs. 5.68±4.69 years,t=1.84,P=0.07; 34.18±16.52 kgvs. 25.03±18.06 kg,t=1.72,P=0.09). Two patients (9%) undergoing thoracoscopy required conversion to small thoracotomy. Perioperative outcomes, including operation time (151.64±74.59 minvs. 136.40±50.36 min,t=0.77,P=0.45), intraoperative blood loss (43.41±45.91 mlvs. 79.50±131.00 ml,t=–1.21,P=0.23), drainage duration (5.00±1.79 dvs. 4.90±2.36 d,t=0.23,P=0.82), length of hospital stay (8.41±3.11 dvs. 8.65±2.66 d,t=–0.27,P=0.79) showed no significant differences between the two groups. One patient suffered pneumonia in thoracoscopy group after operation and the rest patients recovered well without severe complications such as atelectasis, active bleeding and bronchopleural fistula. Conclusion Lobectomy via small thoracotomy and thoracoscopic approach is effective and safe for pediatric patients with equivalent short-term outcomes. While thoracoscopic surgery with relatively small incision achieves good cosmetic outcome.

Citation： JIANG Lianyong, XIE Xiao, HU Fengqing, WANG Lei, HU Rui, XIAO Haibo, WANG Mingsong, LI Guoqing, DING Fangbao, MEI Ju. Short-term outcomes between small thoracotomy and thoracoscopic approach for pediatric lobectomy: A case control study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(3): 183-187. doi: 10.7507/1007-4848.201608087 Copy

1.	Kunisaki SM, Powelson IA, Haydar B, et al. Thoracoscopic vs open lobectomy in infants and young children with congenital lung malformations. J Am Coll Surg, 2014, 218(2): 261-270.
2.	Aziz D, Langer JC, Tuuha SE, et al. Perinatally diagnosed asymptomatic congenital cystic adenomatoid malformation: to resect or not? J Pediatr Surg, 2004, 39(3): 329-334.
3.	Lawal TA, Gosemann JH, Kuebler JF, et al. Thoracoscopy versus thoracotomy improves midterm musculoskeletal status and cosmesis in infants and children. Ann Thorac Surg, 2009, 87(1): 224-228.
4.	Bleiziffer S, Schreiber C, Burgkart R, et al. The influence of right anterolateral thoracotomy in prepubescent female patients on late breast development and on the incidence of scoliosis. J Thorac Cardiovasc Surg, 2004, 127(5): 1474-1480.
5.	Cherup LL, Siewers RD, Futrell JW. Breast and pectoral muscle maldevelopment after anterolateral and posterolateral thoracotomies in children. Ann Thorac Surg, 1986, 41(5): 492-497.
6.	Jaureguizar E, Vazquez J, Murcia J, et al. Morbid musculoskeletal sequelae of thoracotomy for tracheoesophageal fistula. J Pediatr Surg, 1985, 20(5): 511-514.
7.	Santon M, Njere I, Ade-Ajayi N, et al. Systematic review and meta-analysis of the postnatal management of congenital cystic lung lesions. J Pediatr Surg, 2009, 44(5): 1027-1033.
8.	Albanese CT, Rothenberg SS. Experience with 144 consecutive pediatric thoracoscopic lobectomies. J Laparoendosc Adv Surg Tech A, 2007, 17(3): 339-341.
9.	Cano I, Anton-Pacheco JL, Garcia A, et al. Video-assisted thoracoscopic lobectomy in infants. Eur J Cardiothorac Surg, 2006, 29(6): 997-1000.
10.	Rothenberg SS. Experience with thoracoscopic tracheal surgery in infants and children. J Laparoendosc Adv Surg Tech A, 2009, 19(5): 671-674.
11.	Rothenberg SS. Experience with thoracoscopic lobectomy in infants and children. J Pediatr Surg, 2003, 38(1): 102-104.
12.	Rothenberg SS, Kuenzler KA, Middlesworth W, et al. Thoracoscopic lobectomy in infants less than 10 kg with prenatally diagnosed cystic lung disease. J Laparoendosc Adv Surg Tech A, 2011, 21(2): 181-184.
13.	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(1): 74-80.
14.	Byon HJ, Lee JW, Kim JK, et al. Anesthetic management of video-assisted thoracoscopic surgery (VATS) in pediatric patients: the issue of safety in infant and younger children. Korean J Anesthesiol, 2010, 59(2): 99-103.
15.	Choudhry DK. Single-lung ventilation in pediatric anesthesia. Anesthesiol Clin North America, 2005, 23(4): 693-708.
16.	Kumar K, Basker S, Jeslin L, et al. Anaesthesia for pediatric video assisted thoracoscopic surgery. J Anaesthesiol Clin Pharmacol, 2011, 27(1): 12-16.
17.	Rothenberg SS, Middlesworth W, Kadennhe-Chiweshe A, et al. Two decades of experience with thoracoscopic lobectomy in infants and children: standardizing techniques for advanced thoracoscopic surgery. J Laparoendosc Adv Surg Tech A, 2015, 25(5): 423-428.
18.	Dingemann C, Zoeller C, Bataineh Z, et al. Single- and double-lung ventilation in infants and children undergoing thoracoscopic lung resection. Eur J Pediatr Surg, 2013, 23(1): 48-52.
19.	Kulaylat AN, Engbrecht BW, Hollenbeak CS, et al. Comparing 30-day outcomes between thoracoscopic and open approaches for resection of pediatric congenital lung malformations: Evidence from NSQIP. J Pediatr Surg, 2015, 50(10): 1716-1721.
20.	Nasr A, Bass J. Thoracoscopic vs open resection of congenital lung lesions: a meta-analysis. J Pediatr Surg, 2012, 47(5): 857-861.

1. Kunisaki SM, Powelson IA, Haydar B, et al. Thoracoscopic vs open lobectomy in infants and young children with congenital lung malformations. J Am Coll Surg, 2014, 218(2): 261-270.
2. Aziz D, Langer JC, Tuuha SE, et al. Perinatally diagnosed asymptomatic congenital cystic adenomatoid malformation: to resect or not? J Pediatr Surg, 2004, 39(3): 329-334.
3. Lawal TA, Gosemann JH, Kuebler JF, et al. Thoracoscopy versus thoracotomy improves midterm musculoskeletal status and cosmesis in infants and children. Ann Thorac Surg, 2009, 87(1): 224-228.
4. Bleiziffer S, Schreiber C, Burgkart R, et al. The influence of right anterolateral thoracotomy in prepubescent female patients on late breast development and on the incidence of scoliosis. J Thorac Cardiovasc Surg, 2004, 127(5): 1474-1480.
5. Cherup LL, Siewers RD, Futrell JW. Breast and pectoral muscle maldevelopment after anterolateral and posterolateral thoracotomies in children. Ann Thorac Surg, 1986, 41(5): 492-497.
6. Jaureguizar E, Vazquez J, Murcia J, et al. Morbid musculoskeletal sequelae of thoracotomy for tracheoesophageal fistula. J Pediatr Surg, 1985, 20(5): 511-514.
7. Santon M, Njere I, Ade-Ajayi N, et al. Systematic review and meta-analysis of the postnatal management of congenital cystic lung lesions. J Pediatr Surg, 2009, 44(5): 1027-1033.
8. Albanese CT, Rothenberg SS. Experience with 144 consecutive pediatric thoracoscopic lobectomies. J Laparoendosc Adv Surg Tech A, 2007, 17(3): 339-341.
9. Cano I, Anton-Pacheco JL, Garcia A, et al. Video-assisted thoracoscopic lobectomy in infants. Eur J Cardiothorac Surg, 2006, 29(6): 997-1000.
10. Rothenberg SS. Experience with thoracoscopic tracheal surgery in infants and children. J Laparoendosc Adv Surg Tech A, 2009, 19(5): 671-674.
11. Rothenberg SS. Experience with thoracoscopic lobectomy in infants and children. J Pediatr Surg, 2003, 38(1): 102-104.
12. Rothenberg SS, Kuenzler KA, Middlesworth W, et al. Thoracoscopic lobectomy in infants less than 10 kg with prenatally diagnosed cystic lung disease. J Laparoendosc Adv Surg Tech A, 2011, 21(2): 181-184.
13. 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(1): 74-80.
14. Byon HJ, Lee JW, Kim JK, et al. Anesthetic management of video-assisted thoracoscopic surgery (VATS) in pediatric patients: the issue of safety in infant and younger children. Korean J Anesthesiol, 2010, 59(2): 99-103.
15. Choudhry DK. Single-lung ventilation in pediatric anesthesia. Anesthesiol Clin North America, 2005, 23(4): 693-708.
16. Kumar K, Basker S, Jeslin L, et al. Anaesthesia for pediatric video assisted thoracoscopic surgery. J Anaesthesiol Clin Pharmacol, 2011, 27(1): 12-16.
17. Rothenberg SS, Middlesworth W, Kadennhe-Chiweshe A, et al. Two decades of experience with thoracoscopic lobectomy in infants and children: standardizing techniques for advanced thoracoscopic surgery. J Laparoendosc Adv Surg Tech A, 2015, 25(5): 423-428.
18. Dingemann C, Zoeller C, Bataineh Z, et al. Single- and double-lung ventilation in infants and children undergoing thoracoscopic lung resection. Eur J Pediatr Surg, 2013, 23(1): 48-52.
19. Kulaylat AN, Engbrecht BW, Hollenbeak CS, et al. Comparing 30-day outcomes between thoracoscopic and open approaches for resection of pediatric congenital lung malformations: Evidence from NSQIP. J Pediatr Surg, 2015, 50(10): 1716-1721.
20. Nasr A, Bass J. Thoracoscopic vs open resection of congenital lung lesions: a meta-analysis. J Pediatr Surg, 2012, 47(5): 857-861.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Short-term outcomes between small thoracotomy and thoracoscopic approach for pediatric lobectomy: A case control study

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