New bullae formation in the staple line increases the risk of recurrent pneumothorax following video-assisted thoracoscopic surgery bullectomy for primary spontaneous pneumothorax

Choi, Si Young; Kim, Do Yeon; Suh, Jong Hui; Yoon, Jong Seo; Jeong, Jin Yong; Park, Chan Beom

doi:10.21037/jtd.2018.06.07

Cited by 24 publications

(22 citation statements)

References 12 publications

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“…We think that postoperative pneumothorax recurrence is not only caused by margin distance but also by new bulla apart from the resected site (16). In fact, for case 8 in Table 2, new bulla apart from the resected site may be the cause of the recurrence.…”

Section: Discussionmentioning

confidence: 89%

Optimal margin distance of bullectomy for primary spontaneous pneumothorax reduces postoperative recurrence

Tsuboshima¹,

Matoba²,

Wakahara³

2019

J Thorac Dis

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Background: For primary spontaneous pneumothorax, bullectomy using autosutures is the standard procedure. Despite performing various methods for preventing postoperative recurrence, it remains relatively high. Although considering the margin distance of bullectomy is important, no argument has been discussed for the optical margin distance until now. Hence, we evaluated the optimal margin distance for bullectomy of spontaneous pneumothorax, bullectomy to reduce postoperative recurrence. Methods: Between March 2015 and May 2018, 91 eligible candidates from 142 cases, who underwent video-assisted thoracoscopic bullectomy for spontaneous pneumothorax, bullectomy, were evaluated. We analysed the factors preventing postoperative recurrence, including the margin distance using the inverseprobability of treatment weighted method by propensity score was used to adjust for heterogeneous patient backgrounds. Results: The patients' median age was 20 years (range, 14-86 years). Postoperative recurrences occurred in 8 cases (8.8%). The margin distance was 9.1±5.0 mm. The cut-off point of the margin distance was defined as 5.0 mm. The inverse-probability of treatment weighted method indicated that a margin distance ≥5.0 mm significantly prevented postoperative recurrence (P=0.0076, hazard ratio =0.18).Conclusions: This study suggests that a margin distance of ≥5.0 mm for bullectomy of PSP can reduce postoperative recurrence.

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Section: Discussionmentioning

confidence: 89%

Optimal margin distance of bullectomy for primary spontaneous pneumothorax reduces postoperative recurrence

Tsuboshima¹,

Matoba²,

Wakahara³

2019

J Thorac Dis

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“…They performed wedge resection only in case of detection of blebs or air leak intraoperatively (stage III and IV of Vanderschueren's classification), according to literature suggestion, and argued that the major recurrence recorded in bullectomy cohort reflected the worst conditions of the lung parenchyma in those patients. On the other hand, the authors believed that bullectomy alone does not decrease the rate of PSP recurrence, if not associated to pleurodesis, as already proved by other studies (6)(7)(8)(9)(10)(11).…”

mentioning

confidence: 74%

Surgical treatment of primary spontaneous pneumothorax: what is better to do?

Nachira¹,

Meacci²,

Congedo³

et al. 2020

J Thorac Dis

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“…If we consider the time it takes for the neo-bullae to be formed, LR is thought to be more related to neo-bullae genesis. On the other hand, the cause of ER can be explained as a minor air leakage due to the healing process of surgical stapling sites [ 14 ]. Therefore, when PoR occurs in PSP patients, we might apply different treatment strategies depending on the timing of the PoR in the postoperative period.…”

Section: Discussionmentioning

confidence: 99%

Early Postoperative Pneumothorax Might Not Be ‘True’ Recurrence

Woo

Kim

et al. 2021

JCM

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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.

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New bullae formation in the staple line increases the risk of recurrent pneumothorax following video-assisted thoracoscopic surgery bullectomy for primary spontaneous pneumothorax

Abstract: New bullae formation in the staple line increases the risk of recurrent pneumothorax following VATS. Thus, the current concept of VATS bullectomy-resect with sufficient margin-warrants reconsideration.

Cited by 24 publications

References 12 publications

Optimal margin distance of bullectomy for primary spontaneous pneumothorax reduces postoperative recurrence

Optimal margin distance of bullectomy for primary spontaneous pneumothorax reduces postoperative recurrence

Surgical treatment of primary spontaneous pneumothorax: what is better to do?

Early Postoperative Pneumothorax Might Not Be ‘True’ Recurrence

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