Cause and Management of Recurrent Primary Spontaneous Pneumothorax After Thoracoscopic Stapler Blebectomy

Muramatsu, Takashi; Shimamura, Mie; Furuichi, Motohiko; Nishii, Teppei; Takeshita, Shinji; Ishimoto, Shinichiro; Morooka, Hiroaki; Tanaka, Yôko; Yagasaki, Chiyoshi; Ohmori, Kazuo; Shiono, Motomi

doi:10.1016/s1015-9584(11)60022-5

Cited by 16 publications

(12 citation statements)

References 25 publications

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“… 29 The importance of pleurodesis was further stressed by some reports showing the increasing risk of postoperative recurrent pneumothorax due to incomplete resection of bullae 10 or bulla regrowth along staple-lines, 30 and the pleural porosity theory proposed by Noppen et al as a remaining etiology of PSP; 31 in both, the recurrence could be lowered by pleurodesis. 23 , 32 Our study supported that pleurodesis is an independent risk factor in multivariate analysis for the prevention of postoperative pneumothorax recurrence. The majority of our pleurodesis method, a combination of intraoperative mechanical pleurodesis (pleural abrasion) with chemical pleurodesis (by Talc poudrage or minocycline slurry), is a process of evolution and inspiration by the prospective randomized trial by Chen et al 33 in 2006 showing that additional minocycline pleurodesis could significantly lower the recurrence rate after VATS in PSP but with increased immediate chest pain.…”

Section: Discussionsupporting

confidence: 76%

“…Reviewing the literature, several factors have been shown to be associated with the postoperative recurrence in patients with PSP, including young age, 22 , 23 current smoker, 24 missed or incomplete bullectomy, 22 and prolonged postoperative air-leak. 25 Subpleural blebs and bullae are commonly found in the lung apices during thoracoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…However, the procedure alone was debated to be effective enough; hence, the second to create a symphysis between the 2 opposing pleural surfaces as an additional means is rather crucial. 7 , 23 Cumulative evidence had shown that VATS bullectomy combined with mechanical or chemical pleurodesis is effective in preventing the recurrence of pneumothorax, 28 with a low complication rate and only minor pulmonary function changes at 1 year. 29 The importance of pleurodesis was further stressed by some reports showing the increasing risk of postoperative recurrent pneumothorax due to incomplete resection of bullae 10 or bulla regrowth along staple-lines, 30 and the pleural porosity theory proposed by Noppen et al as a remaining etiology of PSP; 31 in both, the recurrence could be lowered by pleurodesis.…”

Section: Discussionmentioning

confidence: 99%

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Apex-to-Cupola Distance Following VATS Predicts Recurrence in Patients With Primary Spontaneous Pneumothorax

et al. 2015

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Our study sought to determine whether the size of the residual apical pleural space in young patients with primary spontaneous pneumothorax (PSP) following video-assisted thoracoscopic surgery is associated with the risk of recurrence.We retrospectively reviewed patients (≤30 years’ old) with primary spontaneous pneumothorax following thoracoscopic surgery (2002–2010) in a university-affiliated hospital. The size of residual apical pleural space was estimated by measuring the apex-to-cupola distance on a postoperative chest radiograph at 2 time windows: first between postoperative day (POD) 0 and 3, and second between POD 4 and 14.A total of 149 patients were enrolled with a median follow-up of 11.2 months (interquartile range, 0.95–29.5 months), of whom 141 (94.6%) were male with a mean age of 20 years. The postoperative recurrence rate was 11.4%. Comparing the characteristics between the patients with and without recurrent pneumothorax, the patients with recurrence were younger (18.2 + 2.4 vs 20.7 + 3.7 years, P = 0.008), with a lower rate of pleurodesis (35% vs1 69%, P = 0.037), longer apex-to-cupola distance at POD 0 to 3 (22.41 ± 19.56 vs 10.07 ± 10.83 mm, P < 0.001) and POD 4 to 14 (11.82 ± 9.75 vs 5.54 ± 8.38 mm, P = 0.005) than the patients without recurrence. In a multivariate logistic regression model for recurrent pneumothorax, age <18 years (P = 0.026, odds ratio [OR]: 4.694), apex-to-cupola distance at POD 0 to 3 >10 mm (P = 0.027, OR: 5.319), and no pleurodesis during VATS (P = 0.022, OR: 5.042) were independent risk factors for recurrent pneumothorax.The recurrence rate was not low (11.4%) in young patients with PSP following VATS. Residual apical pleural space with apex-to-cupola distance of 10 mm or greater at POD 0 to 3, younger age, and no pleurodesis would increase postoperative recurrence of primary spontaneous pneumothorax.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Apex-to-Cupola Distance Following VATS Predicts Recurrence in Patients With Primary Spontaneous Pneumothorax

et al. 2015

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“…It is reported that recurrence rates were higher than expected. There are publications indicating that 90% of the patients treated with thorascoscopic blebektomi, but not the ones treated with pleurodesis, within the first two years, recurrence rate, especially in young bilateral spontaneous pneumothorax patients’ group, has much developed new bül formation in postoperative stapler line, and recurrent pneumothorax rate is higher with traditional surgery method (17). According to the data from the literature, in order to reduce the recurrent rate in primary spontaneous pneumothorax and video assisted thoracic surgery, apical resections as well as apical pleurectomy procedures are recommended (18).…”

Section: Discussionmentioning

confidence: 99%

The Effect of Additional Pleural Procedures onto Recurrence Rates on the Spontaneous Pneumothorax Surgery

Zeybek¹,

Kalemci²,

Alma³

et al. 2013

Iran Red Crescent Med J

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BackgroundSpontaneous pneumothoraxes constituted 1/1000 hospital admissions. They are particularly one of life threatening health issues in combination with bilateral pneumothorax, tension pneumothorax, repertory failure or COPD.ObjectivesThe cases of spontaneous pneumothorax represent a significant portion of the patients profile within the chest surgery clinics. The risk of recurrent pneumothorax in post thoracoscopy is between 2% and 14%, thus the subject of cure treatment and approach is still controversial. The cases were retrospectively treated due to spontaneous pneumothorax and their reasons, treatment approaches and results were comparatively examined with the literature.Patients and MethodsThe years between 2007 and 2010, according to our hospital clinic, outpatients and accident & emergency admission records, 79 patients were admitted with a diagnosis of spontaneous pneumothorax; and the patients’ age, gender, symptoms, types of pneumothorax, surgical intervention and recurrence, average length of stay, mortality and complications were retrospectively evaluated.ResultsSeventy of all the patients (88.6%) were male and 9 of those (13.7%) were female. The mean age was calculated as 45.50 ± 21.07 (0-85). The patients were comprised of 41 (51.9%) with primary spontaneous pneumothorax and 38 (48.1%) with secondary spontaneous pneumothorax. 55 of the patients (69.6%) with the first attack, and 24 patients (30.4%) with post tube thoracotomy’s 2nd or 3rd pneumothorax attack were admitted. Those who were accepted with post tube thoracostomy’s 2nd or 3rd attack made up 2/3 of the secondary spontaneous pneumothorax patients. 57 of the patients (68.4%) were treated with the tube thoracostomy. The tube thoracostomy related complication was 6.3%, hemorrhage due to parenchymal damage and massive air leak were observed. An open surgical method to 22 of those patients and apical resection and apical pleurectomy + tetracycline pleurodesis to 16 of whom and bullae ligation and mechanical abrasion to 6 patients were applied. The recurrence of pneumothorax in post-surgery was not observed for 1-3 year period Complication was not detected .Mortality, one patient (1.3%) died in post tube thoracotomy, which was a stage 4 lung cancer patient.ConclusionsMost cases for pneumothorax were consisted of the patients with the primary spontaneous pneumothorax; the patients with recurrent pneumothorax were comprised of secondary spontaneous pneumothorax patients and those of majority secondary spontaneous pneumothorax patients were observed with bullous emphysema profile. By looking at the pertinent literature, there are publications showing VATS with the recurrence rate ranging from 2% to 14% and post thoracotomy recurrence rate from 0% to 7%. We think that applying pleurectomy, mechanical abrasion and chemical pleurodesis additional to bullae ligation or apical resection in pneumothorax surgery will significantly reduce the recurrence rate.

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“…Patients with disorders of blood sugar control have a greater relative risk for the development of lung cancer. [ 18 ] The growth hormone/insulin like growth factor 1 (IGF-1) axis is considered to contribute to this finding. [ 19 ] IGF-1 is secreted by stimulation of growth hormone, and combines with insulin-like growth factor binding protein-3 in the circulation.…”

Section: Discussionmentioning

confidence: 99%

Patients with spontaneous pneumothorax have a higher risk of developing lung cancer

2020

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Lung cancer is a common malignancy worldwide, and risk factors include bronchitis, asthma, tuberculosis, smoking, and air pollution. These are also risk factors for spontaneous pneumothorax, a benign disease. We hypothesized that patients who experience a spontaneous pneumothorax have a greater risk to develop lung cancer, and designed a study to determine if this is so. We used the population-based Taiwan Health Insurance Research Database to perform a retrospective cohort study. The database includes more than 99% of the population of Taiwan. We established a 27,405-person pneumothorax cohort and a 109,620 person comparison cohort with data from 2000 to 2009 to evaluate the relationship between spontaneous pneumothorax and lung cancer. Multivariable analysis showed that patients who have had a spontaneous pneumothorax have a greater relative risk to develop lung cancer. The overall hazard ratio was 2.09 (95% confidence interval 1.69-2.58) adjusted by age, gender, hypertension, diabetes mellitus, and chronic lung diseases such as chronic obstructive pulmonary disease, tuberculosis, asthma, bronchitis, and emphysema. A dose effect was present; a high frequency of spontaneous pneumothorax was associated with a greater relative risk to develop lung cancer. If the spontaneous pneumothorax frequency was greater than 2 times per year, the hazard ratio was 34.09 (95% confidence interval 22.74-51.10) Patients with spontaneous pneumothorax have an increased relative risk to develop lung cancer, especially among patients 35 to 49 years of age. The more frequent the occurrence of spontaneous pneumothorax, the greater the relative risk of lung cancer. If the spontaneous pneumothorax frequency was greater than 2 times per year, the increase in risk of lung cancer was more than 30-fold.

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Cause and Management of Recurrent Primary Spontaneous Pneumothorax After Thoracoscopic Stapler Blebectomy

Abstract: In thoracoscopic stapler blebectomy for primary spontaneous pneumothorax, the most common cause of recurrence was new bulla formation. It is necessary to establish additional procedures involving either the visceral pleura or the parietal pleura to reduce the recurrence rate.

Cited by 16 publications

References 25 publications

Apex-to-Cupola Distance Following VATS Predicts Recurrence in Patients With Primary Spontaneous Pneumothorax

Apex-to-Cupola Distance Following VATS Predicts Recurrence in Patients With Primary Spontaneous Pneumothorax

The Effect of Additional Pleural Procedures onto Recurrence Rates on the Spontaneous Pneumothorax Surgery

Patients with spontaneous pneumothorax have a higher risk of developing lung cancer

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