Medical Thoracoscopy-Assisted Argon Plasma Coagulation Combined with Electrosurgical Unit for the Treatment of Refractory Pneumothorax in Elderly Patients

Abstract

Purpose: This study aims to compare the effects and prognosis of medical thoracoscopy-assisted argon plasma coagulation (APC) combined with electrosurgical unit (ESU) surgery, video-assisted thoracic surgery (VATS), and pleurodesis surgery, in providing appropriate treatment for elderly refractory pneumothorax patients.Methods: Patients with refractory pneumothorax aged over 65 years were divided into three groups: APC combined with ESU (N = 20), VATS (N = 26), and pleurodesis (N = 24). Data on demographic characteristics, lung function evaluation, and short- and long-term prognoses were collected.Results: Following surgery, compared with the APC-ESU and pleurodesis groups, patients in the VATS group demonstrated poor short-term prognoses, with high pleural effusion drainage levels and high visual analog scores (VAS; P <0.05). After the surgery, St. George’s Respiratory Questionnaire (SGRQ) scores in the pleurodesis group were slightly elevated, whereas SGRQ scores in both the APC-ESU and VATS groups demonstrated a continual decrease. Finally, medical resource consumption analysis demonstrated a significant difference in hospitalization costs among the three groups; the VATS group being the most expensive.Conclusion: Medical thoracoscopy-assisted APC combined with ESU is a safe, effective, and affordable treatment for elderly patients with refractory pneumothorax.

Assessment and review of treatment for secondary spontaneous pneumothorax using medical thoracoscopy-assisted argon plasma coagulation in association with autologous blood pleurodesis

“…Elderly patients have poor tolerance of pneumothorax and difficulty in healing air leaks due to low body mass index, weak chest wall muscles, poor basal lung function, extensive lung lesions, low immunity, and other factors. 21 In the study of APC outcomes by Zhang et al 6 the majority of patients stopped leaking air within 3 days after the surgery. However, some patients continued to leak air after APC, with the leakage in four patients exceeding 1 week.…”

“…On the other hand, APC is an effective, safe, and affordable treatment for recurrent pneumothorax, especially in older patients. 21 The depth of tissue penetration can be controlled with APC, and it is possible to treat “around the corner” lesions. 5 …”

“…On the other hand, APC is an effective, safe, and affordable treatment for recurrent pneumothorax, especially in older patients. 21 The depth of tissue penetration can be controlled with APC, and it is possible to treat "around the corner" lesions. 5 Gan and Liu 18 observed 12 patients with refractory pneumothorax who were treated with thoracoscopic APC, and their air leaks were stopped entirely within 1 week after the procedure.…”

The long‐term survival of esophageal cancer in elderly patients: A multi‐center, retrospective study from China

“…21 Elderly patients with EC have short life expectancy, poor postoperative recovery ability and high risk of perioperative death. 22 Therefore, surgeons should consider the pros and cons of lymph node dissection in elderly patients.…”

“…However, extensive lymph node dissection lengthens the operative time and increases intraoperative bleeding, resulting in increased perioperative complications and mortality 21 . Elderly patients with EC have short life expectancy, poor postoperative recovery ability and high risk of perioperative death 22 . Therefore, surgeons should consider the pros and cons of lymph node dissection in elderly patients.…”