Pediatrics |

Lobectomy in Cystic Fibrosis FREE TO VIEW

Shahid Sheikh, MD; Nancy Ryan-Wenger, APN; Alpa Patel, MD; Karen McCoy, MD; Stephen Kirkby, MD
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Division of Pulmonary Medicine, Department of Pediatrics, Nationwide Children Hospital/Ohio State University, Columbus, OH

Chest. 2013;144(4_MeetingAbstracts):778A. doi:10.1378/chest.1675846
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SESSION TITLE: Pediatric Pulmonary Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Patients with cystic fibrosis (CF) have progressive lung disease. A small proportion of CF patients develop localized destruction of the lung and some may develop recurrent hemoptysis or pneumothorax. Resection of the involved lung is considered an option to limit spread of disease and/or to stop life threatening hemoptysis or air leak. Our objective was to evaluate the usefulness of lung resection in patients with CF and either worsening localized lung disease or recurrent hemoptysis/pneumothorax.

METHODS: After local IRB approval, we reviewed charts of all patients with CF followed at the CF Center at Nationwide Children’s Hospital, Columbus, OH, who underwent lobectomy over the last 15 years (1995-2010). Patients who were followed for at least one year before surgery were included in this study (n=15).

RESULTS: Among our cohort of CF patients (n=520), 15 patients, were included in this report. Median age 20 years (range 2- 41), 93% Caucasian. Mean %FEV1 was 57%. Four patients died and all had mean %FEV1 <40% before surgery. The indication for surgery in 10 (67%) patients was progressive localized lung disease, and 5 (33%) underwent surgery due to either recurrent hemoptysis (n=1) or recurrent pneumothorax (n=3) or both (n=1) refractory to conventional therapy. Among these 5 patients, 4 had surgery emergently. Twelve of 15 (80%) had the right upper lobe removed. The median hospital stay was 14 days (range 8-85), median ICU stay was 2 days (range 2-70), and median days with chest tubes were 7 (range 3-25) In the total cohort, there were no significant changes in mean height, weight, BMI, number of hospital and ED visits, or oral and IV antibiotic use over time but within the group with %FEV1>40%, the number of hospital admissions decreased over time (1.5 vs. 0.5, p=.02). Mean % predicted PFT (FVC, FEV1 and FEV1/FVC) decreased over time but the rate of decline in % FEV1 decreased significantly during the second year post-surgery compared to during the first year post-surgery (p=0.007) in patients with less severe disease (%FEV1<40%) (p=0.005).

CONCLUSIONS: Lobectomy can be useful for some patients with progressive localized lung disease especially if their %FEV1 is >40%. Poor outcomes or lack of clinical improvement are associated with %FEV1 <40%.

CLINICAL IMPLICATIONS: lobectomy is a choice in selected patients with CF and is safer if done when FEV1 is >40%.

DISCLOSURE: The following authors have nothing to disclose: Shahid Sheikh, Nancy Ryan-Wenger, Alpa Patel, Karen McCoy, Stephen Kirkby

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