J.Jpn. Surg. Soc.. 124(6): 492-499, 2023

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Feature topic

INDICATIONS FOR AND CURRENT STATUS OF SEGMENTECTOMY FOR NEONATES AND INFANTS WITH CONGENITAL CYSTIC LUNG DISEASE

Whether it is beneficial for neonates and infants with congenital cystic lung disease to undergo segmentectomy remains an uncertain question in the Japanese clinical guidelines. An indication for segmentectomy exists in neonates and infants with bronchial atresia or small-sized intra-lobar pulmonary sequestrations (PSs), which have a clear borderline of the lesions without any communication with the normal tracheobronchial trees. In some cases with more than one lesion in different lobes, segmentectomy is preferred to minimize the resection of normal parenchyma. Bronchial atresia is defined as malformation of the pulmonary parenchyma resulting from atresia of the bronchus or bronchiole. Distal pulmonary parenchyma is often emphysematous, with mucus plugs in the distal bronchus. The cystic lesions in bronchial atresia are similar to those of CPAM type 2, a pathogenetic mechanism also thought to be an obstruction of the bronchus. PS is defined as abnormal pulmonary tissue lacking any connection to the tracheobronchial tree and has an anomalous systemic arterial supply. Intralobar PS is located within the lung tissue and lacks its visceral pleura. Small-sized intralobar PS may be completely resectable with segmentectomy. Although problems with postoperative pneumothorax and late complications, including recurrence and infection of the residual lesions, remain, the safety and feasibility of the surgical technique of segmentectomy for neonates and infants have been established.

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