Evidence-based approach to congenital thoracic malformations
File(s)
Accepted version
Author(s)
Bush, A
Type
Journal Article
Abstract
There is a clear need for more evidence as to how to deal with asymptomatic congenital thoracic malformations (CTMs), and thus the recent series from Great Ormond Street Hospital1 and the accompanying editorial2 are to be welcomed; however, the evidence review is incomplete. The risk of complications in non-operated CTMs after the postnatal period over around a decade was estimated at 3.2% in a meta-analysis.3 Although pleuropulmonary blastoma (PPB) may develop de novo postnatally, undoubtedly PPB may develop in a CTM, as may other malignancies, and the biggest population based study from Canada estimated the risk of PPB as 4% in ‘benign’ resected CTM;4 worryingly there were no radiological features to differentiate them. Unfortunately, and contrary to the editorial statement,2 complete resection of a CTM does not eliminate the risk of malignancy.5 6 Finally, rare but fatal cases of air embolism in adults with a CTM during commercial flight have been described.7 8 Clearly the vast majority of CTMs remain asymptomatic for decades, posing a difficult decision for already anxious parents with a totally well infant. I suggest the above data should be shared with parents in an open discussion, so that informed choices can be made. Personally, I consider the risks of thoracoscopic surgery in competent hands should be far less than the risk of complications, and advocate elective removal of all but the most trivial CTMs, while respecting the views of parents and professionals who disagree. Certainly the follow-up protocol proposed by Cook et al for those non-resected CTMs should be tested prospectively in the sort of big international study which will be truly definitive.
Date Issued
2017-08-18
Date Acceptance
2017-07-13
Citation
ARCHIVES OF DISEASE IN CHILDHOOD, 2017, 102 (11), pp.1095-1095
ISSN
0003-9888
Publisher
BMJ PUBLISHING GROUP
Start Page
1095
End Page
1095
Journal / Book Title
ARCHIVES OF DISEASE IN CHILDHOOD
Volume
102
Issue
11
Copyright Statement
© 2017 Article author(s) (or their employer(s) unless otherwise stated in the text of the article). All rights reserved. No commercial use is permitted unless otherwise expressly granted. This article has been accepted for publication in Archives of Disease in Childhood following peer review. The definitive copyedited, typeset version
Bush A Evidence-based approach to congenital thoracic malformations Archives of Disease in Childhood 2017;102:1095, is available online at: https://dx.doi.org/10.1136/archdischild-2017-313708
Bush A Evidence-based approach to congenital thoracic malformations Archives of Disease in Childhood 2017;102:1095, is available online at: https://dx.doi.org/10.1136/archdischild-2017-313708
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000413348600022&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
Science & Technology
Life Sciences & Biomedicine
Pediatrics
CYSTIC ADENOMATOID MALFORMATION
PLEUROPULMONARY BLASTOMA
POSTNATAL MANAGEMENT
LUNG LESIONS
1103 Clinical Sciences
1114 Paediatrics And Reproductive Medicine
1117 Public Health And Health Services
Publication Status
Published