The safety of conservative management of asymptomatic congenital pulmonary airway malformations (CPAMs) in children: A systematic review.
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PURPOSE: The optimal management of infants born with asymptomatic congenital pulmonary airway malformations (CPAMs) remains controversial. However, emerging evidence increasingly supports a conservative non-operative approach for these patients. We aimed to evaluate this evidence with the hope of clarifying optimal management for these patients. METHODS: A comprehensive search strategy was developed. Electronic databases MEDLINE and Embase Classic + Embase were searched from inception to December 7th, 2023. EBM Reviews and APA PsycInfo were searched from inception to November 30th, 2023. The primary outcome was complications during expectant management. Secondary outcomes included failure of conservative management resulting in surgical intervention, age at time of surgery if required, presence of malignancy, and length of follow-up. RESULTS: Ten studies met inclusion criteria, involving 298 patients managed conservatively for asymptomatic CPAM. Among these, 49 individuals (16 %) experienced complications, most commonly pneumonia and chronic cough. A total of 58 patients (20 %) eventually underwent surgical resection due to complications, lesion progression, or parental preference. No cases of malignancy were identified in resected specimens, and no deaths were reported. The majority of lesions were diagnosed antenatally (87 %), by X-ray and CT scan. The duration of follow-up among included studies varied substantially, ranging from 12 to 96 months. These findings support the safety of conservative management and indicate a low risk of serious adverse outcomes with medium-term follow-up. CONCLUSION: In asymptomatic patients with mainly antenatally diagnosed lesions, conservative management of CPAM lesions was associated with a complication rate and no reported cases of mortality or malignancy. We hope this information can aid informed and safe shared decision-making with patients and their families. LEVEL OF EVIDENCE: V. TYPE OF STUDY: Reviews, Systematic Reviews, Meta-Analyses, and Guidelines.