Initial management of primary spontaneous pneumothorax with video-assisted thoracoscopic surgery: a 10-year experience

Herrmann, Dominik; Klapdor, Benjamin; Ewig, Santiago; Hecker, Erich

doi:10.1093/ejcts/ezv206

Cited by 27 publications

(21 citation statements)

References 23 publications

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“…PSPs are very common diseases that are frequently treated surgically (Onuki et al, ). The most common cause of PSP is rupture of an apical subpleural bleb, which could be found in operation (Herrmann et al, ); An imbalance of cell–extracellular matrix interactions appears to be associated with this disease (Chiu et al, ). However, the underlying etiology of such a bleb still remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Correlation between Sternal Slope Angle and Primary Spontaneous Pneumothorax in Young Males, a Propensity Score Match Analysis

Liu

Cheng

et al. 2019

Clinical Anatomy

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It is generally accepted that primary spontaneous pneumothorax (PSP) is found mostly in tall, thin young males. However, the precise etiology of PSP is unclear. We compared some thoracic structural angles of PSPs and controls in young males to determine the predominant factor. CT data of 43 male PSPs (age 21.88 AE 5.30) and 30 controls (age 21.47 AE 5.47) were collected. The angle of thoracic vertebrae slope (∠α), sternal slope angle (∠β), and tracheal-sternal stem angle (∠γ) were measured in the sagittal position. Carina angle (∠δ) was measured in the coronal position. After a propensity score match (PSM) of age and smoking history, the angles were comparatively evaluated. There were significant differences in all four angles between two unmatched groups, while only in three (∠β, ∠γ, and ∠δ) after PSM was performed. The correlation between ∠β and PSP was most significant, and R 2 was 0.456. The prediction accuracy of ∠β was 81.3%, OR was 1.386, 95% confidence interval was (1.095-1.754). The sternal slope angles in PSPs are greater than controls indicate the sternal slope angle is associates with the development of PSP and it could be a thoracic structural index to predict the risk of PSP occurrence. Clin. Anat. 33:605-609, 2020.

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Section: Discussionmentioning

confidence: 99%

Correlation between Sternal Slope Angle and Primary Spontaneous Pneumothorax in Young Males, a Propensity Score Match Analysis

Liu

Cheng

et al. 2019

Clinical Anatomy

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“…It is stated that patients with synchronous or metachronous bilateral pneumothorax, with prolonged air leak (PAL), and who have a highrisk occupation must be operated when recurrence is detected [5][6][7]. It is reported in some of the studies that patients can be surgically treated by VATS in the first attack [3,8,9]. In our department, only the patients with PAL underwent surgical treatment in the first attack.…”

Section: Discussionmentioning

confidence: 99%

Axillary thoracotomy and vats for the treatment of primary spontaneous pneumothorax

Ünal¹,

Samancılar²,

Gülmez³

et al. 2017

Curr Thorac Surg

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“…A case series of 185 patients in a single center, suggested a recurrence rate of 2.2%, but a high procedurerelated morbidity rate of 7.6% and a mortality of 1.6%. 68 There have now been two RCTs of early VATS compared to conservative management after first PSP: the first by Al-Mourgi and Alshehri 69 was a small trial of 41 patients, in which the VATS group underwent surgery within 24 hours of admission to hospital compared to "conservative" treatment with chest tube drainage. 69 They found no recurrence (0%) in the VATS group, compared to 40.9% in the conservative group, which is higher than previously reported.…”

Section: Recurrence Prevention After First Occurrence?mentioning

confidence: 99%

Pneumothorax—Time for New Guidelines?

Hallifax

Janssen

2019

Semin Respir Crit Care Med

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Pneumothorax is a common pathology, but optimal management strategies are not yet defined. There are significant differences in international guidelines and therefore variation in clinical practice.There is increasing interest in pneumothorax research, particularly primary spontaneous pneumothorax (PSP), with evidence of lung abnormalities in this group without clinically apparent lung disease and recently completed clinical trials aiming to optimize management. The most robust evidence base is that of the equivalence of needle aspiration and chest tube insertion for initial management of PSP; although, patients with secondary spontaneous pneumothorax may also benefit. A convincing case for surgical intervention or thoracoscopy and talc poudrage to prevent recurrence at first episode in PSP has yet to be made. Clinicians should be vigilant for PSP being the first manifestation of a systemic disease, and should have a low threshold for onward referral. Time to change guidelines? First, chest tube drainage and hospitalization without recurrence prevention should no longer be standard treatment, as this has no advantage over the less invasive manual aspiration, which moreover can be performed on an outpatient basis in an important number of patients. The results of recent trials in conservative and ambulatory management are eagerly awaited. Second, shared decision-making should become more important with the well-informed patient, who may want to avoid a 1 in 3 recurrence rate and therefore will have the possibility to choose treatment including recurrence prevention even after the first episode of PSP. Third, surgical research should urgently make clear if the current practice of resection of emphysema-like changes is routinely necessary, alongside pleurodesis. Future studies should utilize risk stratification by clinical and radiological parameters (e.g., high-resolution computed tomography scanning and digital air leak monitoring) to predict short- and long-term outcomes, and hence personalize management.

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Initial management of primary spontaneous pneumothorax with video-assisted thoracoscopic surgery: a 10-year experience

Cited by 27 publications

References 23 publications

Correlation between Sternal Slope Angle and Primary Spontaneous Pneumothorax in Young Males, a Propensity Score Match Analysis

Correlation between Sternal Slope Angle and Primary Spontaneous Pneumothorax in Young Males, a Propensity Score Match Analysis

Axillary thoracotomy and vats for the treatment of primary spontaneous pneumothorax

Pneumothorax—Time for New Guidelines?

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