Review ArticleSurgical versus conservative management of congenital pulmonary airway malformation in children: A systematic review and meta-analysis
Section snippets
Selection of study topic
We used a Dephi-like method [17] to determine the issues of greatest concern to pediatric surgeons regarding the surgical management of CPAM.
Studies included
Our electronic search yielded 342 studies. After applying our exclusion criteria to titles and abstracts, 63 studies remained. Full-text review resulted in eight of these studies being included, while an additional one was identified from hand-searching the reference sections of included articles; nine studies were ultimately included [10], [11], [12], [14], [23], [24], [25], [26], [27]. Seven of these were amenable to inclusion in meta-analyses [10], [11], [12], [14], [23], [24], [25] (Fig. 1).
Summary and comparison with the literature
With the wide use of antenatal ultrasound, CPAM is often diagnosed before birth, and may remain asymptomatic for years. Whether asymptomatic children should undergo elective lung resection is disputed [6], [7]. We have attempted to compare patients who underwent resection of CPAM lesions while asymptomatic to those who were managed expectantly and had surgery only upon the development of symptoms, in terms of morbidity and length of stay in hospital.
We identified nine studies reporting on a
Conclusions
Based on our results, we recommend elective resection of asymptomatic CPAM lesions, rather than expectant management. Lung resection in an asymptomatic patient is quite safe, prevents the risk of symptom development later in life, and may help prevent the development of malignancy. The ideal timing of elective resection will be the topic of a future review.
Acknowledgments
The University of Ottawa Summer Studentship program provided financial support for this project. We thank Colin Way for his help quality assessing included articles and Katrina Sullivan for proof-reading the manuscript.
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