Delayed thoracoscopic lobectomy in symptomatic newborns with congenital pulmonary airway malformation

Surgery for symptomatic congenital pulmonary airway malformation (CPAM) is uncontroversial. However emergency surgery for neonates with CPAM presented as progressive respiratory distress still carries high risks. This article introduces a new strategy aimed at improving the safety and effectiveness of surgery. 4 neonates were diagnosed with CPAM with mediastinal shift by prenatal diagnosis and experienced progressive respiratory distress after birth. Insertion of a chest drain in the main cyst of the CPAM was performed as effective interim management to relieve respiratory distress, and delayed thoracoscopic lobectomy was performed after the stabilization. Thoracoscopic lobectomy was successfully performed in all 4 cases. The average operation time was 96.2 min, the mean blood loss volume was 10.0 ml, the postoperative recovery was uneventful, the postoperative ventilatory support time was 2.7 d and the time to postoperative discharge was 14.2 d. No death, pulmonary infection, bleeding, atelectasis, bronchopleural fistula, chylothorax or other postoperative complications occurred. During the follow-up of 6 months to 4 years, there was no respiratory morbidity. Delayed thoracoscopic lobectomy for symptomatic CPAM in neonates is safe and effective. Prior to surgery, it is essential to evaluate for possible associated malformations and to achieve preoperative stabilization by transthoracic drainage of the main cyst to relieve respiratory distress.