Is video-assisted thoracoscopic surgery talc pleurodesis superior to talc pleurodesis via tube thoracostomy in patients with secondary spontaneous pneumothorax?

Study of the Relative Frequency of Spontaneous Pneumothorax Recurrence with Two Policy Therapies: A Clinical Trial

Background

Spontaneous pneumothorax is a potentially fatal condition with a high risk of recurrence. The purpose of this study is to compare two different approaches to SP management. In the first group, patients underwent only chemical pleurodesis; in the second group, CT-scan, VATS, and then chemical pleurodesis was performed.

Materials and Methods

This study is a non-randomized clinical trial conducted on 65 patients admitted to Al-Zahra Hospital in Isfahan with a primary complaint of sudden dyspnea and a definitive diagnosis of spontaneous pneumothorax. Two studies compared the main outcomes of recurrence within six months and the time until recurrence.

Results

Age, sex, and BMI were matched between the two study groups. The side of the pneumothorax, smoking history, and pulmonary disease history did not differ significantly (P > 0.05). Pneumothorax recurrence did not differ significantly between the two groups (P: 0.477).

Conclusion

This study demonstrated no distinction between VATS and chemical pleurodesis when using only chemical pleurodesis. However, because numerous studies have suggested that one of these techniques may be beneficial for patients with SP, it is recommended to conduct additional randomized controlled trials (RCTs) with a more detailed plan and more comparable procedures, although it appears that meta-analysis design may be effective given the abundance of available RCT studies.

Video-Assisted Thoracoscopic Surgery with Bullectomy and Partial Pleurectomy versus Chest Tube Drainage for Treatment of Secondary Spontaneous Pneumothorax-A Retrospective Single-Center Analysis

Background and objective: Current guidelines recommend chest tube (CT) drainage as the initial treatment of secondary spontaneous pneumothorax (SSP). Surgery should be considered in cases of persistent air leak or recurrent disease. Video-assisted thoracoscopic surgery (VATS) is nowadays an established surgical treatment for complicated spontaneous pneumothorax. However, reports on VATS-bullectomy with partial pleurectomy (VBPP) for treatment of secondary spontaneous pneumothorax (SSP) are limited. The primary aim of this study was to evaluate and compare the clinical outcomes of patients with secondary pneumothorax treated either by VBPP or CT drainage in our institution. Secondly, we assessed underlying clinical parameters to identify potential risk factors for SSP recurrence. Materials and Methods: Eighty-two patients were included in this study. Long-term recurrence rates and potential risk factors for SSP recurrence were analyzed. Results: Thirty-six patients (43.9%) underwent VBPP, whereas 46 (56.1%) patients subsequently underwent CT treatment. During a median follow-up period of 76.5 months, VBPP patients experienced a significantly low recurrence rate compared to CT patients (VBPP vs. CT: 16.7% vs. 41.3%; p = 0.016). However, VBPP was associated with a higher complication rate and significantly longer length of hospital stay (LOS). Male sex (male vs. female: p = 0.021) and CT treatment (VBPP vs. CT: p < 0.001) were identified as potential risk factors for SSP recurrence. Conclusions: VBPP is a suitable surgical treatment for SSP. However, prolonged LOS and possible complications should be discussed prior to VBPP.

Management of the Secondary Spontaneous Pneumothorax: Current Guidance, Controversies, and Recent Advances

Secondary spontaneous pneumothorax (SSP) is a medical emergency where the lung collapses in the presence of underlying chronic lung disease. It is the commonest cause of spontaneous pneumothorax and results in significant breathlessness, higher morbidity, mortality, and longer hospital admissions than with patients with pneumothoraces and no underlying lung disease. This article explores the current guidance, controversies, and recent advances in the management of this condition.

A systematic review and meta-analysis of video-assisted thoracoscopic surgery treating spontaneous pneumothorax

Background

With the adoption of high-tech thoracoscopic surgical instruments, video-assisted thoracoscopic surgery (VATS) has gradually replaced traditional thoracotomy and is used in the clinical treatment of spontaneous pneumothorax.

Methods

The composite logic retrieval and Boolean logic retrieval methods were adopted for this meta-analysis. Databases such as PubMed, Medline, Cochrane Library, CNKI, Wanfang, VIP, and Google Scholar were searched using the combination of search terms “Video-assisted thoracoscopic surgery”, “spontaneous pneumothorax”, and “thoracotomy”. Literatures which used video-assisted thoracoscopic surgery for spontaneous pneumothorax as the experimental group were screened. The software RevMan 5.3 provided by the Cochrane system was employed for meta-analysis.

Results

A total of 12 studies were included. After the meta-analysis, heterogeneity testing of the operation time in 8 studies showed that Tau² =29.99, Chi² =16.99, degrees of freedom (df) =7, I²=59%>50%, and the operation time of participants in the experimental group was considerably inferior to that of control group. The mean difference (MD) was −31.02, 95% confidence interval (95% CI: −36.07 to −25.97), Z=12.03, P<0.0001. The heterogeneity test of the length of hospital stay in 9 studies showed that Tau² =4.41, Chi² =122.58, df =8, I²=59%>50%, P<0.01, and the length of hospital stay of participants in the experimental group was remarkably shorter than that of the control group. The MD was −7.29, 95% CI: (−8.76 to −5.82), Z=9.74, and P<0.01. The heterogeneity test of the bleeding volume in 6 studies showed that Tau² =191.74, Chi² =27.65, df =5, I²=82%>50%, P<0.01, and the bleeding volume of participants in the experimental group was remarkably lower in contrast to that of the control group. The MD was −65.48, 95% CI: (−77.84 to −53.13), Z=10.39, and P<0.01. The heterogeneity test of the chest tube removal time in 7 studies showed that Tau² =0.29, Chi² =28.27, df =6, I²=79%>50%, P<0.05, and the chest tube removal time of participants in the experimental group was substantially lower in contrast to that of the control group. The MD was −3.10, 95% CI: (−3.56 to −2.64), Z=13.30, P<0.01.

Discussion

This meta-analysis confirmed that VATS for spontaneous pneumothorax is better than other surgical methods.

Surgical treatment for secondary spontaneous pneumothorax: a risk factor analysis

PURPOSE

While surgery is an effective treatment for secondary spontaneous pneumothorax (SSP), it can be difficult, because affected patients are usually in a poor general condition. The present study investigated the risk factors of postoperative complications after surgery for SSP.

METHODS

Eighty-eight patients with SSP who underwent surgery from January 2006 to March 2018 were investigated. Clinical data were reviewed, and a multivariate analysis was performed.

RESULTS

Eighty-four patients (95%) were males, and the median patient age was 72 years. Underlying lung diseases were chronic obstructive pulmonary disease in 58 patients (65.9%), interstitial pneumonia in 26 (29.5%), and others in 4 (4.5%). Postoperative complications developed in 21 patients (24%). Hospital mortality/prolonged length of stay occurred in 6 patients (7%). A multivariate analysis showed that the preoperative performance status (performance status 0-2 vs. 3, hazard ratio: 6.570, 95% confidence interval: 1.980-21.800) was an independent predictor of postoperative complications.

CONCLUSION

Surgery for SSP contributed to early chest tube removal and favorable outcomes. However, rare fatal events occurred, and the patient performance status was a risk factor for postoperative complications. A careful evaluation of each patient's performance status is needed to determine the need for surgical intervention for SSP.

Recurrence of spontaneous pneumothorax six years after VATS pleurectomy: evidence for formation of neopleura

Background

Primary Spontaneous Pneumothorax (PSP) is considered an absolute and definitive contraindication for scuba diving and professional flying, unless bilateral surgical pleurectomy is performed. Only then is there a sufficiently low risk of recurrence to allow a waiver for flying and/or diving.

Case presentation

A young fit male patient who suffered a PSP 6 years ago, and underwent an uncomplicated videoscopic surgical pleurectomy, presented with a complete collapse of the lung on the initial PSP side. Microscopic examination of biopsies showed a slightly inflamed tissue but otherwise normal mesothelial cells, compatible with newly formed pleura.

Conclusions

Even with pleurectomy, in this patient, residual mesothelial cells seem to have had the capacity to create a completely new pleura and pleural space. The most appropriate surgical technique for prevention of PSP may still be debated.

Empyema from Obstructing Lung Cancer

Pleural collections on the side of an obstructing bronchial cancer pose a particular challenge. All efforts should be placed into determining whether the collection is malignant or para-malignant with its significant implications on cancer staging. This article discusses various diagnostic modalities and therapeutic interventions needed for the optimal management of patients presenting with this situation. The order of interventions is dictated by the individual circumstances that patients present with, often requiring the pleural interventions to take place ahead of the bronchial obstruction management.

The outcome and risk factors for recurrence and extended hospitalization of secondary spontaneous pneumothorax

PURPOSE

Secondary spontaneous pneumothorax (SSP) is difficult to treat by itself and due to its association with serious underlying diseases. It has a high rate of recurrence and often requires extended hospitalization. Therefore, we evaluated the outcome and risk factors associated with recurrence and extended hospitalization.

METHODS

We retrospectively examined 61 patients with SSP, and evaluated the patients' characteristics, underlying diseases, introduction of home oxygen therapy, Brinkman index, and X-ray imaging findings to determine the risk factors for recurrence and extended hospitalization.

RESULTS

There were 28 patients (46.0%) with chronic obstructive pulmonary disease, 8 (13.1%) with interstitial pneumonia, 16 (26.2%) with massive emphysema, and 9 (14.8%) with other diseases. Adhesion and mediastinal shift visualized by X-ray imaging were observed in 37 (37.9%) and 25 patients (40.1%), respectively. Recurrence occurred in 25 patients (40.9%) and the average hospitalization duration was 14.5 days (±11.2). A multivariate analysis showed that adhesion on X-ray imaging was a significant risk factor for recurrence (odds ratio 4.90, 95% confidence interval 1.38-21.44) and mediastinal shift on X-ray imaging was a significant risk factor for extended hospitalization (odds ratio 6.05, 95% confidence interval 1.44-31.06).

CONCLUSIONS

Findings from X-ray imaging, and not underlying diseases, are risk factors for recurrence and extended hospitalization.