Long term pulmonary function test result after lobectomy for congenital pulmonary airway malformation: is thoracoscopic approach really better than open?

Abstract

Background: Congenital pulmonary airway malformation (CPAM) is the most common lung pathology diagnosed antenatally. Theoretically patients can have compensatory lung growth after lobectomy if done at an early age. Thoracoscopic lobectomy has become popular in recent years but the long-term result of this relatively new approach is still lacking. In this study we tried to compare the long-term pulmonary function test (PFT) result between patients who underwent thoracoscopic and open lobectomy. Materials and methods: All patients who underwent lobectomy for CPAM between 2000 and 2010 were recruited into the study. PFT was performed at least 7 years after the operation. Demographic data and PFT results were studied. Test result less than 80% of predicted value was considered abnormal. Comparison was made between the thoracoscopic and open group. Results: 12 thoracoscopic and 12 open patients were identified. PFT was performed at a mean age of 9.8 and 12.2 years respectively (p=0.17). The thoracoscopic group showed better performance in forced vital capacity (FVC) (98.9 vs 84.3% predicted, p=0.03), forced expiratory volume in 1 second (FEV1) (88.5 vs 76.1% predicted, p=0.04) and alveolar volume adjusted diffusion capacity of carbon monoxide (106.4 vs 91.4% predicted, p= 0.03). Other parameters including FEV1 to FVC ratio, total lung capacity, vital capacity and residual volume showed no statistical difference between the 2 groups. Conclusion: Patients who underwent thoracoscopic lobectomy has superior PFT result in the long run. This maybe due to impaired respiratory musculature after thoracotomy. Further study with larger sample size is necessary to determine this hypothesis.