Risk factors for recurrence of primary spontaneous pneumothorax after thoracoscopic surgery

Asano, Hiroaki; Ohtsuka, Takashi; Noda, Yuki; Kato, Daisuke; Mori, Shiro; Nakada, Takeo; Matsudaira, Hideki

doi:10.21037/jtd.2019.04.105

Cited by 17 publications

(22 citation statements)

References 11 publications

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“…This lack of associations contrasts with previously published studies. Predictors of increased recurrence rate after surgery for PSP have previously been identified for smoking (17,18), younger age (19,20), female sex (17,18), VATS approach (21), and greater disease severity (14).…”

Section: Discussionmentioning

confidence: 99%

Recurrence of primary spontaneous pneumothorax following bullectomy with pleurodesis or pleurectomy: A retrospective analysis

2021

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Background: Primary spontaneous pneumothorax is managed initially with observation and chest tube placement, followed by surgical intervention in select cases. With little currently published evidence, the role of surgical pleurodesis or pleurectomy to reduce primary spontaneous pneumothorax recurrence is unclear.This study compares the recurrence rates of primary spontaneous pneumothorax following bullectomy alone versus bullectomy with pleurodesis or pleurectomy. Methods: A retrospective review was performed at a quaternary hospital for all patients undergoing surgery for primary spontaneous pneumothorax between June 2006 and December 2018. Patient demographics, disease severity, operative technique, and time between initial surgery and recurrence were recorded.Standard statistical techniques were used for univariable and multivariable analyses. Results: Of 222 total included patients, 28 required a second surgery: 4 (1.8%) for prolonged air leak and 24 (10.8%) for recurrent pneumothorax. The median time from first to second surgery was 363 days and 35.7% of recurrences did not present until after two years. Age, sex, smoking, year of initial surgery, disease severity, and surgical technique did not significantly affect recurrence rate on univariable analysis.On multivariable analysis, the odds ratios of recurrence for bullectomy with mechanical pleurodesis or pleurectomy were respectively 0.82 and 0.15 (P=0.218), compared to bullectomy alone. Combined bullectomy, pleurectomy, and pleurodesis was most effective (0/18, 0%). Conclusions: Bullectomy with pleurectomy and pleurodesis demonstrated a 0% recurrence rate for the treatment of primary spontaneous pneumothorax in this study. Statistical significance was not achieved in univariable or multivariable analyses comparing recurrence rates for the surgical approaches. A multi-center randomized controlled trial with longer follow-up than previously performed is needed to confirm these preliminary findings and optimize surgical management of primary spontaneous pneumothorax.

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Section: Discussionmentioning

confidence: 99%

Recurrence of primary spontaneous pneumothorax following bullectomy with pleurodesis or pleurectomy: A retrospective analysis

2021

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“…Most importantly, we found a higher incidence of postoperative recurrence of pneumothorax in CaS than in NS. Asano observed a relationship between the detection of blebs/bullae on CT-scans and a low recurrence rate, perhaps because such identification led to easier intraoperative detection and appropriate resection [21]. Conversely, in our series, the presence of major bullous changes and the difficulty of properly resecting all lesions may be hypothesized as causes of recurrence in CaS.…”

Section: Plos Onementioning

confidence: 52%

Secondary spontaneous pneumothorax and bullous lung disease in cannabis and tobacco smokers: A case-control study

et al. 2020

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Background The notion that smoking cannabis may damage the respiratory tract has been introduced in recent years but there is still a paucity of studies on this subject. The aim of this study was to investigate the relationship between cannabis smoking, pneumothorax and bullous lung disease in a population of operated patients. Methods and findings We performed a retrospective study on patients operated on for spontaneous pneumothorax. Patients were divided into three groups according to their smoking habit: cannabis smokers, only-tobacco smokers and nonsmokers. Cannabis lifetime exposure was expressed in dose-years (1d/y = 1 gram of cannabis/week for one year). Clinical, radiological and perioperative variables were collected. The variables were analyzed to find associations with smoking habit. The impact of the amount of cannabis consumption was also investigated by ROC curves analysis. Of 112 patients, 39 smoked cannabis, 23 smoked only tobacco and 50 were nonsmokers. Median cannabis consumption was 28 dose/years, median tobacco consumption was 6 pack/ years. Cannabis smokers presented with more severe chronic respiratory symptoms and bullous lung disease and with a higher incidence of tension pneumothorax than both tobacco smokers and nonsmokers. Cannabis smokers also developed a larger pneumothorax, experienced prolonged postoperative stay and demonstrated a higher incidence of pneumothorax recurrence after the operation than nonsmokers did. The risk of occurrence of chronic respiratory symptoms and bullous lung disease in cannabis smokers was dose-related. Conclusions Cannabis smoking seems to increase the risk of suffering from respiratory complaints and can have detrimental effects on lung parenchyma, in a dose-dependent manner. Cannabis smoking also negatively affected the outcome of patients operated for spontaneous

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“…Bullectomy should be considered in patients with recurrent pneumothorax. However, postoperative recurrence is relatively common after bullectomy 3 – 6 . Thus, several additional procedures including the use of fibrin sealants, radiofrequency therapy, and simultaneous pleurectomy or pleurodesis with bullectomy have been described to minimize the recurrence of PSP 5 , 7 – 10 .…”

Section: Introductionmentioning

confidence: 99%

Simultaneous Viscum pleurodesis and video-assisted thoracic surgery (VATS) bullectomy in patients with primary spontaneous pneumothorax

Jung

Kim

2021

Sci Rep

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Although surgery is the gold standard for treatment of primary spontaneous pneumothorax (PSP), recurrence after surgery remains a concern. This study sought to evaluate the efficacy of simultaneous pleurodesis using Viscum album (VA) extract and video-assisted thoracic surgery (VATS) bullectomy for the treatment of PSP. From March 2016 to June 2020, 175 patients with PSP underwent bullectomy and intraoperative pleurodesis with VA extract at a single institution. All operations were performed through thoracoscopy by one surgeon. Upon completion of bullectomy, a polyglycolic acid sheet was used to cover the stapler lines, and 40 mg of VA extract was instilled over the entire chest wall before chest tube placement. The median operating time was 20 min (interquartile ranges, 15–30) and the median indwelling time of chest drainage was 2 days (interquartile ranges, 2–3). There were no postoperative complications over grade 3. During the median follow-up period of 38 months (interquartile ranges, 15–48), no recurrence of pneumothorax was observed. The results of this study demonstrated that simultaneous Viscum pleurodesis and VATS bullectomy provides a feasible and effective treatment option for preventing postoperative pneumothorax in patients with PSP.

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Risk factors for recurrence of primary spontaneous pneumothorax after thoracoscopic surgery

Cited by 17 publications

References 11 publications

Recurrence of primary spontaneous pneumothorax following bullectomy with pleurodesis or pleurectomy: A retrospective analysis

Recurrence of primary spontaneous pneumothorax following bullectomy with pleurodesis or pleurectomy: A retrospective analysis

Secondary spontaneous pneumothorax and bullous lung disease in cannabis and tobacco smokers: A case-control study

Simultaneous Viscum pleurodesis and video-assisted thoracic surgery (VATS) bullectomy in patients with primary spontaneous pneumothorax

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