Primary spontaneous pneumothorax: a cohort study of VATS with talc poudrage

Cardillo, Giuseppe; Bintcliffe, Oliver; Carleo, Francesco; Carbone, Luigi; Martino, Marco; Kahan, Brennan C; Maskell, Nick A

doi:10.1136/thoraxjnl-2015-207976

Cited by 49 publications

(29 citation statements)

References 33 publications

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“…In Europe, graded talc has been used for many decades as an efficient, well‐tolerated and cheap agent of pleurodesis as opposed to other areas such as Brazil and USA . There are recent and large European prospective series definitely showing that graded talc is safe . A review of 50 studies including 9 randomized control studies, 10 prospective case series and 31 retrospective case series concluded that talc poudrage is associated with a recurrence rate ranging from 2.5 to 10% .…”

Section: What Is Presently the Best Chemical Agent For Pleurodesis Asmentioning

confidence: 99%

New insights and improved strategies for the management of primary spontaneous pneumothorax

Plojoux

Froudarakis

Janssens

et al. 2019

Clinical Respiratory J

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The pathophysiology and management of primary spontaneous pneumothorax (PSP) are a subject of debate. Despite advances in the understanding of its etiopathogenesis and improvements in its management, implementation in clinical practice is suboptimal. In this manuscript, we review the recent literature with a focus on PSP pathophysiology and management. Blebs and emphysema‐like changes (ELC) are thought to contribute to the pathophysiology of PSP but cannot explain all cases. Recent studies emphasize the role of a diffuse porosity of the visceral pleura. Others found a relationship between smoking, occurrence of a PSP and bronchiolitis, which could be the initial pathological process leading to ELC development. Recent or ongoing studies challenge the need to systematically remove air from the pleural cavity of stable patients, introducing conservative management as a valuable therapeutic option. Evidence is growing in favour of needle aspiration instead of chest tube insertion, when air evacuation is needed. In addition, ambulatory management is considered as a successful approach in meta‐analyses and is under exploration in a large randomized study. Because of a high recurrence rate of PSP, the benefit of performing a pleurodesis at first occurrence is under evaluation with interesting but not generalizable results. Better identification of ‘at risk patients’ is needed to improve the investigation strategy. Finally, recent publications confirm the efficacy, security and cost‐effectiveness of graded talc poudrage pleurodesis to prevent PSP recurrence. In conclusion, PSP pathophysiology and management are still under investigation. The results of recently published and ongoing studies should be more widely implemented in clinical practice.

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Section: What Is Presently the Best Chemical Agent For Pleurodesis Asmentioning

confidence: 99%

New insights and improved strategies for the management of primary spontaneous pneumothorax

Plojoux

Froudarakis

Janssens

et al. 2019

Clinical Respiratory J

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“…Talc poudrage administration during VATS from eight studies, including over 2300 patients, had a recurrence rate of between 0.0% and 2.9%. These data together with the recently published Italian series of PSP patients undergoing talc poudrage at the time of surgery11 suggest that VATS is highly effective at preventing recurrence and is well tolerated and should be the treatment of choice in cases of recurrence or prolonged air leak. What is less certain is whether this should be performed using talc poudrage or pleurectomy/abrasion and this should be the focus of a future RCT.…”

Section: Introductionmentioning

confidence: 75%

Pneumothorax management: time to improve the evidence base

Maskell

2017

Thorax

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“…64 This was confirmed further in two large case series of VATS with talc poudrage with a reported recurrence rates of 1.7 65 and 1.9%. 66 Alternatively, patients with PAL or failed NA can be sent for medical thoracoscopy and talc poudrage with a recurrence rate of 5% compared to 34% for chest tube drainage in a prospective randomized study. 67…”

Section: Managing Prolonged Air Leak Thoracic Surgery or Thoracoscopymentioning

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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Primary spontaneous pneumothorax: a cohort study of VATS with talc poudrage

Cited by 49 publications

References 33 publications

New insights and improved strategies for the management of primary spontaneous pneumothorax

New insights and improved strategies for the management of primary spontaneous pneumothorax

Pneumothorax management: time to improve the evidence base

Pneumothorax—Time for New Guidelines?

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