Clinical Outcomes in Neonates Undergoing Lung Resection
We read the letter from Beuy Joob and Viroj Wiwanitkit in response to our article
“Evaluation of Clinical Outcome in Neonates Undergoing Lung Resection for Congenital
Lesions” published recently in your journal.[1] The authors stated that patient preparation and underlying health condition of the
patients are two main concerns and should have been discussed in more detail. They
also mentioned that thoracoscopy is the ideal surgical technique in such patients.
In our study, we evaluated and followed up the children by clinical parameters as
well as with imaging studies. Of the 26 patients, 5 children required surgery on emergency
basis, and 4 of them had congenital lobar emphysema. The patients with congenital
cystic adenomatoid malformation (CCAM) and one patient with bronchogenic cyst presented
with secondary infection of the affected lobe and reported to us only after they failed
to respond to conservative treatment under care of pediatrician. These patients were
admitted under our care, and surgery was offered only after their clinical condition
stabilized or improved. Patients in this group, in fact, had most of the postoperative
complications that we recorded in our series. Three asymptomatic patients in the series
could have been followed up without surgery. But we decided on surgical treatment,
as these patients hailed from remote areas and could not have reported in time in
the event of any complications. Risk of developing malignancy in future in such benign
lesions was also another concern. Objective tests, such as lung function test, were
not employed during follow-up in our series. There is a lack of consensus in the literature
regarding recovery of lung function following lung resection or ideal age of the patient
at the time of surgery as we have discussed in the article. A recent study has shown
that surgical treatment appears to be safe at all ages, with no mortalities and similar
rates of complications between age groups.[2] Although thoracoscopy is the ideal surgical procedure in such patients, it is a
technically demanding procedure and has a long learning curve.[3] In a meta-analysis, Downard et al found that there were only few articles in the
available English literature providing definitive recommendations for care of the
patient with a congenital airway malformations and none reported level I or II evidence.[4] The author recommended early resection of such lesions.
