Male Adolescents with Contralateral Blebs Undergoing Surgery for Primary Spontaneous Pneumothorax May Benefit from Simultaneous Contralateral Blebectomy

Abstract

Background: In adults with primary spontaneous pneumothorax (PSP), contralateral recurrence occurs in about 25-28% when there are asymptomatic blebs. How to treat contralateral recurrence of PSP in pediatric populations remains controversial. This study evaluated the outcomes of excising contralateral blebs to prevent recurrence in adolescents being operated on for PSP under the same anesthesia. Methods: One hundred thirty-two male PSP patients under age 19 were surgically treated in a single institution between January 2008 and December 2016. Thoracoscopic blebectomies with pleurodesis were performed in all patients. For the purpose of this study, the patients were categorized into those with contralateral blebs receiving one-stage bilateral surgeries (32 patients), those with contralateral blebs only receiving unilateral surgery (40 patients), and those without contralateral blebs only receiving unilateral surgery (60 patients). Perioperative details and postoperative outcomes were retrospectively analyzed.Results: Significant differences in contralateral recurrence were found among the three groups (0%, 30%, and 1%, respectively; P<0.001). Multivariate analysis showed that being under 16.5 years old was a risk factor for overall recurrence (hazard ratio [HR]=2.81, P =0.034). Moreover, patients had contralateral blebs who only received unilateral surgery were at greater risk of overall recurrence (HR=6.06, P =0.004). Kaplan-Meier analysis showed that contralateral and overall recurrence-free survival differed among the three groups (P<0.0001, P =0.0002). Conclusions: Although younger male PSP adolescents treated with surgery were more likely to have postoperative recurrences, the performance of simultaneous contralateral blebectomy in those receiving one-stage bilateral surgeries significantly reduced future contralateral recurrence without compromising patient safety.