Treatment of congenital cystic adenomatoid malformation: should lobectomy always be performed?

BACKGROUND: Although parenchyma-saving resection makes it possible to preserve the lung parenchyma, most surgeons are reluctant to perform it for congenital cystic adenomatoid malformation (CCAM) because it could also result in recurrent pulmonary infection or residual lesion. This study compared the early and late postoperative outcomes according to the extent of resection in CCAM patients to determine if the extent of resection would influence the short- and long-term results.

METHODS: Between 1995 and 2006, 45 patients underwent surgical resection for CCAM. Ten patients received a segmentectomy and 2 a wedge resection (the parenchyma-saving group), and 32 received a lobectomy and 1 a pneumonectomy (the lobectomy group). A retrospective analysis was done to compare the early and late postoperative outcomes between two groups.

RESULTS: No significant differences were observed for severity and duration of preoperative symptoms. No in-hospital or late deaths occurred. There were no significant differences in the incidence of early postoperative complications and late morbidities between the two groups. No significant differences were observed between the two groups for hospital length of stay and duration of chest tube placement.

CONCLUSIONS: The early and late outcomes were excellent even after parenchyma-saving resection in patients with CCAM. We suggest that parenchyma-saving resection can be safely performed in selected patients with a well-confined CCAM lesion and thereby avoiding pneumonectomy in children.