Early Postoperative Pneumothorax Might Not Be ‘True’ Recurrence

Abstract

Objectives: To date, there is no consensual definition of what constitutes a postoperative recurrence of primary spontaneous pneumothorax (PSP), despite there being many studies reporting a high incidence of recurrence. This study aims to describe the long-term recurrence rates of pneumothorax and to suggest a possible way to differentiate recurrence events based on temporal patterns. Methods: This single-center study retrospectively evaluated all postoperative recurrence of PSP from January 2007 to May 2019. Patients’ demographics, history of pneumothorax, radiologic data, surgical technique, and the time between operation and recurrence were analyzed. Univariate and multivariable analyses were conducted to find potential risk factors related to long-term recurrence. Results: Of the 77 postoperative recurrent cases of pneumothorax, 21 (27.2%) occurred within 30 days after surgery and, thus, were classified as early recurrences (ER), while the remaining cases were classified as late recurrences (LR). There was no difference in preoperative variables between the two groups. However, the rate of incidence of second recurrence (SR), which represented a long-term prognosis, was significantly higher in the LR group (28.6% vs. 4.8%, p = 0.030). On univariate and multivariable analyses, late recurrence was the only significant factor predicting later recurrence events. Conclusion: Postoperative recurrence (PoR) within 30 days had a lower SR rate. Therefore, it might not be a ‘true’ postoperative recurrence with a favorable prognosis. Further studies investigating postoperative recurrence based on temporal patterns would be warranted to improve the classification of PoR.

Oxidized Regenerated Cellulose versus Polyglycolic Acid for Pleural Coverage in Pneumothorax Surgery

“…Therefore, a larger coverage area could help minimize the risk of early neo-bullae formation near the staple line. In addition, early recurrence in the PGA group may be related to the healing process or detachment of the coverage materials from the lung [24]. To understand different recurrence-free intervals, further studies including more patients with follow-up and sequential radiologic examination are needed.…”

Special Issue on “Clinical Research of Spontaneous Pneumothorax”

“…This Special Issue in the Journal of Clinical Medicine (JCM) brings together a series of high-quality scientific contributions that try to weave a common thread that extends from the etiology to the treatment of SP [ 1 , 2 , 3 , 4 , 5 ]. The covered topics distinctly point out the issues related to PSP and SSP, although both diseases present some similar approaches in the diagnostic–therapeutic path.…”

“…There is not a clear and established definition of postoperative recurrence of pneumothorax. Woo and colleagues attempted in their study to suggest a new classification system for the postoperative recurrence of SP [ 4 ] and tried to identify risk factors that could be related to a second recurrence. Following other reports, authors concluded that a pneumothorax occurring within 30 days from surgery should not be considered a true recurrence but part of the healing process [ 4 , 28 , 29 ].…”

“…Woo and colleagues attempted in their study to suggest a new classification system for the postoperative recurrence of SP [ 4 ] and tried to identify risk factors that could be related to a second recurrence. Following other reports, authors concluded that a pneumothorax occurring within 30 days from surgery should not be considered a true recurrence but part of the healing process [ 4 , 28 , 29 ]. They demonstrated that patients with postoperative recurrence within 30 days showed a better prognosis than patients with late recurrent episodes.…”