Does Timing of Resection Influence the Presence of Inflammation within Congenital Lung Malformations?

Abstract

Introduction Opinion remains divided on whether to resect an asymptomatic congenital lung malformation (CLM) and on optimal timing of resection. This study aimed to determine if age at resection of CLM correlates with the presence of histological inflammation and/or incidence of prior antibiotic administration for lower respiratory tract infection (LRTI).

Materials and Methods A retrospective review of all CLMs resected between 2009 and 2021 was carried out. Data on antenatal detection, incidence of preoperative antibiotic use for LRTI, operative details, and histological reports were analyzed. Fisher's exact test and logistic regression were used to look for correlation between age at resection and (1) histological inflammation and/or (2) preoperative LRTI.

Results A total of 102 patients underwent resection at age 14 months (interquartile range: 6–23). Eighty percent of children were asymptomatic in the neonatal period and 22% of these went on to develop a respiratory symptom. In total, 59% of specimens had histological evidence of inflammation, with a significantly higher rate of inflammation after 10 months of age (71 vs. 35%; p = 0.0012). Logistic regression showed there was a positive correlation between age at resection and treatment for previous LRTI (p = 0.020).

Conclusion Detection rates of inflammation in specimens resected after 10 months of age are double the rates of those resected prior to 10 months. Delaying resection of CLMs showed a higher frequency of treatment of LRTI. Earlier resection may therefore be advantageous for centers pursuing a resection strategy for asymptomatic lesions.

Keywords

congenital lung malformation - inflammation - timing of resection - pediatric - infection

Publication History

Received: 01 June 2022

Accepted: 04 October 2022

Accepted Manuscript online:
09 October 2022

Article published online:
11 December 2022

• References

• 1 Stocker LJ, Wellesley DG, Stanton MP, Parasuraman R, Howe DT. The increasing incidence of foetal echogenic congenital lung malformations: an observational study. Prenat Diagn 2015; 35 (02) 148-153
• 2 Fan D, Xia Q, Wu S. et al. Prevalence of prenatally diagnosed congenital cystic adenomatoid malformation among fetuses in China. Oncotarget 2017; 8 (45) 79587-79593
• 3 Lau CT, Kan A, Shek N, Tam P, Wong KK. Is congenital pulmonary airway malformation really a rare disease? Result of a prospective registry with universal antenatal screening program. Pediatr Surg Int 2017; 33 (01) 105-108
• 4 Kunisaki SM, Saito JM, Fallat ME. et al; Midwest Pediatric Surgery Consortium. Fetal risk stratification and outcomes in children with prenatally diagnosed lung malformations: results from a multi-institutional research collaborative. Ann Surg 2022; 276 (05) e622-e630
• 5 Peters RT, Burge DM, Marven SS. Congenital lung malformations: an ongoing controversy. Ann R Coll Surg Engl 2013; 95 (02) 144-147
• 6 Morini F, Zani A, Conforti A. et al. Current management of congenital pulmonary airway malformations: a “European Pediatric Surgeons' Association” survey. [published correction appears in Eur J Pediatr Surg 2018;28:e1] Eur J Pediatr Surg 2018; 28 (01) 1-5
• 7 Lo AY, Jones S. Lack of consensus among Canadian pediatric surgeons regarding the management of congenital cystic adenomatoid malformation of the lung. J Pediatr Surg 2008; 43 (05) 797-799
• 8 Chen Y, Zhao B, Xi F, Wang Y, Yang M, Luo Q. The prenatal ultrasonic character and postnatal follow-up of 227 microcystic and macrocystic congenital cystic adenomatoid malformations. J Obstet Gynaecol 2021; 41 (04) 562-568
• 9 Kumar V. Pulmonary innate immune response determines the outcome of inflammation during pneumonia and sepsis-associated acute lung injury. Front Immunol 2020; 11: 1722
• 10 Randall TD. Bronchus-associated lymphoid tissue (BALT) structure and function. Adv Immunol 2010; 107: 187-241
• 11 Lowe K, Alvarez DF, King JA, Stevens T. Perivascular fluid cuffs decrease lung compliance by increasing tissue resistance. Crit Care Med 2010; 38 (06) 1458-1466
• 12 Foo SY, Phipps S. Regulation of inducible BALT formation and contribution to immunity and pathology. Mucosal Immunol 2010; 3 (06) 537-544
• 13 Kumar V, Abbas AK, Aster JC. Robbins Basic Pathology. 10th ed.. Philadelphia, PA: Elsevier – Health Sciences Division; 2021: 95
• 14 Stanton M, Njere I, Ade-Ajayi N, Patel S, Davenport M. Systematic review and meta-analysis of the postnatal management of congenital cystic lung lesions. J Pediatr Surg 2009; 44 (05) 1027-1033
• 15 Cook J, Chitty LS, De Coppi P, Ashworth M, Wallis C. The natural history of prenatally diagnosed congenital cystic lung lesions: long-term follow-up of 119 cases. Arch Dis Child 2017; 102 (09) 798-803
• 16 Calvert JK, Lakhoo K. Antenatally suspected congenital cystic adenomatoid malformation of the lung: postnatal investigation and timing of surgery. J Pediatr Surg 2007; 42 (02) 411-414
• 17 Pelizzo G, Barbi E, Codrich D. et al. Chronic inflammation in congenital cystic adenomatoid malformations. An underestimated risk factor?. J Pediatr Surg 2009; 44 (03) 616-619
• 18 Liu C, Yu X, Cheng K. et al. Hidden infection in asymptomatic congenital lung malformations-a decade retrospective study. Front Pediatr 2022; 10: 859343
• 19 Chang WC, Zhang YZ, Wolf JL. et al. Mucinous adenocarcinoma arising in congenital pulmonary airway malformation: clinicopathological analysis of 37 cases. Histopathology 2021; 78 (03) 434-444
• 20 Casagrande A, Pederiva F. Association between congenital lung malformations and lung tumors in children and adults: a systematic review. J Thorac Oncol 2016; 11 (11) 1837-1845
• 21 Cuypers P, De Leyn P, Cappelle L, Verougstraete L, Demedts M, Deneffe G. Bronchogenic cysts: a review of 20 cases. Eur J Cardiothorac Surg 1996; 10 (06) 393-396
• 22 Coussens LM, Werb Z. Inflammation and cancer. Nature 2002; 420 (6917): 860-867
• 23 Greten FR, Grivennikov SI. Inflammation and cancer: triggers, mechanisms, and consequences. Immunity 2019; 51 (01) 27-41
• 24 Style CC, Cass DL, Verla MA. et al. Early vs late resection of asymptomatic congenital lung malformations. J Pediatr Surg 2019; 54 (01) 70-74