The Primary Spontaneous Pneumothorax trial: A critical appraisal from the surgeon's perspective

Giles, Andrew E.; Kidane, Biniam; Schellenberg, Morgan; Ball, Chad G.; Brown, Carl J; Dixon, Elijah; Datta, Neel; Park, Jason; Dossa, Fahima; Farooq, Ameer; Baxter, Nancy N.; Brar, Mantaj S.; Chaudhury, Prosanto; deMontburn, Sandra; Dimick, Justin B.; Fitzgerald, Bill; Hendren, Samantha; Kao, Lillian S.; Kirkpatrick, Andrew W.; Latosinsky, Steve; McLeod, Robin S.; Morris, Arden M.; Pawlik, T.; Søreide, Kjetil; Sund, Malin; Winter, D. C.; Wjinhoven, Bas

doi:10.1016/j.jtcvs.2021.02.070

Cited by 5 publications

(7 citation statements)

References 16 publications

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“…Most patients with PSP, however, present apical blebs, small bullae or emphysema-like changings (ELC), barely detectable by the pre-operative imaging, which make the above-mentioned definition obsolete and inappropriate [ 2 , 3 ]. Due the high frequency of PSP, most of the main thoracic societies worldwide faced with it; nevertheless, PSP represents an enigmatic condition since little attention has been dedicated to its surgical management [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Cold coagulation in thoracoscopic treatment of primary pneumothorax: a comparison with apicectomy

Aprile

Bacchin

Marrama

et al. 2023

Interdisciplinary CardioVascular and Thoracic Surgery

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Objectives Primary spontaneous pneumothorax is a common disease, whose surgical treatment is still enigmatic in terms of timing and technique. Herein, we reported our experience with the parenchymal sparing technique via cold coagulation, in comparison to stapler apicectomy. Methods We retrospectively collected data of all patients with apical blebs or < 2cm bullae treated with minimally invasive surgery for recurrent or persistent spontaneous pneumothorax, from 2010 to 2020. Two different surgical techniques were used: stapler apicectomy and the parenchymal sparing cold coagulation of the apex. Perioperative and long-term results were analysed and compared. Results Out of 177 patients enrolled, 77 patients (CC-group) underwent cold-coagulation of the apex while 100 patients (SA-group) were treated with stapler apicectomy. Two groups were comparable in terms of age, surgical indication, intraoperative findings and affected side. CC-group had a mean operative time of 43.2 min (SD ± 19.5), shorter than SA-group with 49.3 min (SD ± 20.1, p-value : 0.050). Complications rate was significantly different between two groups, 5 (7%) and 16 (16%), for CC- and SA-group, respectively (p : 0.048), even if not in term of prolonged post-operative air-leak (p : 0.16). During the follow-up, 13 homolateral recurrences were reported: 2 (3%) in group CC and 11 (11%) in group SA; with a significant difference (p : 0.044). All reinterventions (post-operative prolonged air-leak and recurrences) required a stapler apicectomy. Conclusions Parenchymal sparing technique through cold coagulation of apical blebs and bullae is an effective treatment for primary spontaneous pneumothorax and guarantees a good immediate lung sealing, despite stapling still represents the choice treatment in complex cases.

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Section: Introductionmentioning

confidence: 99%

Cold coagulation in thoracoscopic treatment of primary pneumothorax: a comparison with apicectomy

Aprile

Bacchin

Marrama

et al. 2023

Interdisciplinary CardioVascular and Thoracic Surgery

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“… 3 At least 11% of patients may have recurrent episodes of PSP within five years. 4 However, the recurrence rate may be as high as 26.5% within one year or up to 54% over five years. 5–7 …”

Section: Introductionmentioning

confidence: 99%

“…Although there are several treatment options available for PSP, such as observation, intercostal chest drainage (ICD), or surgical intervention, there have been few randomized controlled trials in which two or more of these options were compared head-to-head. 4 One randomized controlled trial found that conservative treatment may be non-inferior to ICD treatment. 8 However, 15% of patients with PSP must still undergo pleural drainage via ICD.…”

Section: Introductionmentioning

confidence: 99%

“… 8 However, 15% of patients with PSP must still undergo pleural drainage via ICD. 4 Pulmonary rehabilitation may also be beneficial for PSP. Deep breathing exercises with or without incentive spirometer have been shown to improve lung parameters including vital capacity (72.12% to 86.24%), force vital capacity, force expiratory volume in one second, and maximal voluntary ventilation.…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated with Duration of Intercostal Chest Drainage in Patients with Primary Spontaneous Pneumothorax and the Role of Pulmonary Rehabilitation

Namwaing¹,

Chaisuksant²,

Sawadpanich³

et al. 2021

OAEM

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Purpose Primary spontaneous pneumothorax (PSP) is an urgent/emergency condition. Treatment with intercostal chest drainage (ICD) is necessary, particularly in symptomatic patients or those with tension. A previous study found that systematic breathing exercise significantly reduced ICD duration when compared with controls. This study aimed to evaluate if pulmonary rehabilitation can reduce the duration of ICD treatment in patients with PSP. Patients and Methods This was a retrospective study of patients diagnosed with PSP treated with ICD. Duration of ICD treatment was recorded from patients’ medical charts. Factors associated with ICD duration were calculated using linear regression analysis. Results There were 66 patients who met the study criteria, with average (SD) age and body mass index of 31.68 (13.53) years and 20.94 (2.72) kg/m 2 . The majority of the patients were male (72.73%), and average (SD) duration of ICD treatment was 9.90 (7.83) days. Three factors remained in the final model: body mass index, systolic blood pressure, and recurrent PSP. Two factors were independently associated with longer ICD duration: systolic blood pressure and recurrent PSP, with adjusted coefficients of 0.21 (p value 0.041) and 7.69 (p value 0.039), respectively. Pulmonary rehabilitation was not included in the final model. Conclusion Patients with a history of recurrent PSP or high systolic blood pressure at presentation may require longer ICD duration. Pulmonary rehabilitation was not associated with the duration of ICD treatment.

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“…Management of SP over the decades has been mainly conservative and, until now, no randomized trials have compared conservative treatment and surgery [ 7 ]. The indications for treatment were provided by the American College of Chest Physicians in 2001 and the European Respiratory Society in 2015 [ 8 , 9 ].…”

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confidence: 99%

Special Issue on “Clinical Research of Spontaneous Pneumothorax”

Ciriaco

2022

JCM

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The Primary Spontaneous Pneumothorax trial: A critical appraisal from the surgeon's perspective

Abstract: Expectant management of moderate and large primary spontaneous pneumothorax may be reasonable with appropriate patient counseling, recognizing that a sizeable proportion still require intervention.

Cited by 5 publications

References 16 publications

Cold coagulation in thoracoscopic treatment of primary pneumothorax: a comparison with apicectomy

Cold coagulation in thoracoscopic treatment of primary pneumothorax: a comparison with apicectomy

Factors Associated with Duration of Intercostal Chest Drainage in Patients with Primary Spontaneous Pneumothorax and the Role of Pulmonary Rehabilitation

Special Issue on “Clinical Research of Spontaneous Pneumothorax”

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