Influence of lung resection volume on risk of primary spontaneous pneumothorax recurrence

Choi, Si Young; Kim, Young Du; Kim, Do Yeon; Suh, Jong Hui; Yoon, Jong Seo; Kim, Yeo Rok; Yu, Eun Kyung; Park, Chan Beom

doi:10.21037/jtd.2018.01.146

Cited by 13 publications

(12 citation statements)

References 8 publications

(12 reference statements)

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“…The findings of the chest X-ray and HRCT were reviewed using the Picture Archiving Communication System. The assessment method of the longest length and the specimen volume are described elsewhere (7). The presence of new bullae and pneumothorax in HRCT was assessed by two thoracic surgeons (C.B.P.…”

Section: Methodsmentioning

confidence: 99%

“…Recently, numerous etiologies of recurrent pneumothorax following VATS have been proposed. While missed bullae have been recognized as the reason for recurrent pneumothorax following VATS, new bullae formation is now being considered an important etiology (4)(5)(6)(7). We have previously reported that higher tension in the staple line which was associated with bulky resection during VATS, increased the risk of recurrence (7).…”

Section: Original Articlementioning

confidence: 99%

See 1 more Smart Citation

New bullae formation in the staple line increases the risk of recurrent pneumothorax following video-assisted thoracoscopic surgery bullectomy for primary spontaneous pneumothorax

Choi¹,

Kim²,

Suh³

et al. 2018

J. Thorac. Dis.

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Section: Methodsmentioning

confidence: 99%

Section: Original Articlementioning

confidence: 99%

New bullae formation in the staple line increases the risk of recurrent pneumothorax following video-assisted thoracoscopic surgery bullectomy for primary spontaneous pneumothorax

Choi¹,

Kim²,

Suh³

et al. 2018

J. Thorac. Dis.

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“…Presentation of a tumour as recurrent pneumothorax is not well recognised, yet a few cases of other tumours with similar presentations have been reported in the literature. These include primary pulmonary synovial sarcoma,12 bronchial carcinoid tumour,13 squamous cell lung cancer,14 cystic lung metastases from epithelioid sarcoma,15 mucoepidermoid carcinoma,16 non-small cell lung cancer and diffuse pleural mesothelioma 16. In about 2% of cases with spontaneous pneumothorax, underlying malignancy would be present 17.…”

Section: Discussionmentioning

confidence: 99%

Occult solitary fibrous tumour of the pleura presenting as recurrent spontaneous pneumothorax

Geboes,

Van den Eynde,

Malfait

et al. 2024

BMJ Case Rep

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A woman in her 30s, non-smoker, presented at the emergency department two times because of spontaneous pneumothorax. The first episode was treated with small bore catheter drainage, while during the second episode—occurring only 1 week later—thoracoscopic talcage was attempted. The postoperative course was characterised by slow clinical and radiological resolution, and recurrence 3 days after discharge. Eventually, multiportal video-assisted thoracoscopic exploration identified an interfissural solid mass. Resection and further work-up revealed the diagnosis of ‘low-risk’ solitary fibrous tumour (SFT) stage pT1N0M0. The interdisciplinary tumour board advised no adjuvant therapy. A CT thorax was scheduled in 1 year for follow-up. The patient was discharged without complications and has had no recurrences of pneumothorax at 6 months of follow-up. This report shows that SFT can easily be missed on initial presentation and should be considered in the differential diagnosis of pneumothorax, especially when frequently recurring.

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“…As the lung weight increased, new bulla formation was more common [6]. Choi et al [19] estimated lung volume using pathologic specimens and concluded that bulky resection was associated with an increase in recurrence. However, the unique apical space should be considered, so we designed our study to only include patients who underwent apical bullectomy for PSP, and we also considered that the resected lung was originally cone-shaped.…”

Section: Discussionmentioning

confidence: 99%

Should We Consider the Resected Lung Volume in Primary Spontaneous Pneumothorax?

2020

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Background Although bullectomy is the most curative treatment in primary spontaneous pneumothorax (PSP), postoperative recurrence is not uncommon. New bulla formation at the staple line is the most common cause of recurrence. However, the mechanism is not known. We believe that the pressure gradient plays the main role in new bulla formation. A large resection amount induces a prolonged pressure gradient for obliteration of the residual space. This study aimed to identify the association between resected lung volume and recurrence. Methods The medical records of patients who underwent video‐assisted thoracoscopic surgery (VATS) bullectomy were reviewed between October 2010 and December 2017. A total of 396 patients underwent surgery for spontaneous pneumothorax. The electronic medical records (EMRs) of the patients were reviewed. Patients with secondary spontaneous pneumothorax were excluded. Patients who were diagnosed with emphysema on CT were excluded. Patients with PSP were excluded from the study if the bulla was not located in the apex or if there was no ruptured bulla at the time of the operation. Patients who lacked EMRs were also excluded. We reviewed the medical records of 276 patients. The apical resected lung volume was estimated using a conical volumetric formula with the use of the specimen size. The risk factors for postoperative recurrence were analyzed. Results The median age was 19 years old (range 13–36). A total of 261 patients were male (94.6%). The median body weight and body mass index (BMI) were 58 kg (range 40–82) and 18.92 (range 15.21–26.47), respectively. In 24 patients, both sides were operated on simultaneously. The resected lung volume was obtained by using a conical volumetric formula, and the value was divided by the BMI value. The median value was 1.43 (0.03–5.67). The median operative time was 35 min (range 15–120). The median postoperative day was 4 (range 2–12). Age (p = 0.006), the value of the resected lung volume divided by BMI (p = 0.003), bilateral bullectomy (p = 0.013) and transverse diameter (p = 0.034) were associated with postoperative recurrence according to the univariate analysis. According to the multivariate analysis, age and the value of the lung volume divided by BMI were significant risk factors for postoperative recurrence. Conclusions Younger age and a large resected lung volume and a low BMI are associated with postoperative recurrence after VATS bullectomy for PSP.

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Influence of lung resection volume on risk of primary spontaneous pneumothorax recurrence

Cited by 13 publications

References 8 publications

New bullae formation in the staple line increases the risk of recurrent pneumothorax following video-assisted thoracoscopic surgery bullectomy for primary spontaneous pneumothorax

New bullae formation in the staple line increases the risk of recurrent pneumothorax following video-assisted thoracoscopic surgery bullectomy for primary spontaneous pneumothorax

Occult solitary fibrous tumour of the pleura presenting as recurrent spontaneous pneumothorax

Should We Consider the Resected Lung Volume in Primary Spontaneous Pneumothorax?

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