Impact of Changes in the Profiles of Patients' Backgrounds on the Indications of Thoracoscopic Lobectomy for Congenital Lung Malformations: A Multicenter Retrospective Study in Southern Japan

Abstract

Introduction

The number of patients with congenital lung malformations (CLM) is increasing because of prenatal diagnosis. We investigated the changes in the patient backgrounds and the surgical approach for lobectomy, evaluating the surgical outcomes of thoracoscopic surgery.

Methods

We enrolled 50 CLM patients who underwent lobectomy between 1995 and 2024. Patients were divided into three 10-year groups to evaluate the trends in patient backgrounds. We also divided them into the thoracotomy and thoracoscopy groups to compare the patient backgrounds and surgical outcomes.

Results

An increase in the prenatal diagnosis rate (p < 0.01) resulted in a decreased preoperative infection rate (p = 0.04), a younger age at surgery (p = 0.03), and an extended preoperative interval (p = 0.03). The cutoff value for predicting the presence of preoperative complications based on surgical age was 1.26 years (area under the curve [AUC]: 0.72, 95% confidence interval [CI]: 0.57–0.86, sensitivity: 0.73, specificity: 0.70). Thoracoscopic surgery was introduced stepwise from 2016, ultimately accounting for 30.0% of all cases. The thoracoscopy group showed significantly less blood loss (thoracotomy: 4.5 [2.0–11.5] mL/kg, thoracoscopy: 1.0 [0.0–2.8] mL/kg, p < 0.01) and a shorter length of hospital stay (thoracotomy: 11.0 [8.8–20.3] days, thoracoscopy: 6.0 [5.0–8.0] days, p < 0.01) compared to the thoracotomy group. Thoracoscopy tended to have a shorter time to chest drain removal than thoracotomy.

Conclusion

The present study demonstrates a recent trend toward an earlier diagnosis and the indications for thoracoscopic surgery for CLM. Thoracoscopic surgery is performed safely, improving surgical outcomes compared to thoracotomy even in regional, non-high-volume centers.