Surgical management of congenital cystic lung malformations in older patients

Background: Congenital cystic malformations of the lung often go unrecognized in childhood. It is controversial whether surgical management in older patients requires more extensive lung resection. The aim of our study was to analyze the outcomes of surgical management in older patients. Methods: A retrospective review was made of all patients treated surgically for congenital cystic lung lesion between 1994 and 2009. Results: One hundred two patients (65 women, 37 men) underwent surgery for a congenital cystic lung lesion. Median age was 47 years (range, 4 to 80 years). Surgical approach was through a thoracotomy in 70 patients, thoracoscopy in 21, sternotomy in 5, mediastinoscopy in 4, and laparoscopy and cervical in 1 each. Simple enucleation of the cyst was done in 67 patients, but 35 required more extensive pulmonary resection: lobectomy in 20, segmentectomy in 8, wedge in 6, and bilobectomy in 1. There was no significant difference between these groups with respect to age, sex, or postoperative outcomes. Univariate analysis revealed pneumonia, complex cysts, male sex, left-sided lesions, and bronchogenic cysts as predictors of a concomitant pulmonary resection being necessary during removal of the lesions. In a multivariable model, pneumonia and bronchogenic cysts persisted as predictors of the need for a more extensive pulmonary resection. Conclusions: A cystic malformation can be resected by simple resection, but in approximately one third of cases, a more extensive pulmonary resection is required. Patients with bronchogenic cysts who present with recurrent pneumonia are more likely to require a more extensive pulmonary resection.