Surgical treatment versus conventional chest tube drainage in primary spontaneous pneumothorax: a randomized controlled trial†

Olesen, Winnie Hedevang; Katballe, Niels; Sindby, Jesper Eske; Titlestad, Ingrid Louise; Andersen, Poul Erik; Lindahl-Jacobsen, Rune; Licht, Peter B.

doi:10.1093/ejcts/ezy003

Cited by 64 publications

(62 citation statements)

References 24 publications

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“…Presence of bullae ≥ 1 cm on high‐resolution CT was an independent predictor of a decrease in PSP recurrence after surgery (HR: 0.3; 95% CI 0.12‐0.63). However, three patients from the VATS group experienced bleeding requiring reoperation and the length of the hospital stay was significantly longer in this group . Further studies are needed to better define the place of first‐line surgery in the management of PSP.…”

Section: In Case Of a First Episode Of Psp Is It Indicated To Performentioning

confidence: 96%

New insights and improved strategies for the management of primary spontaneous pneumothorax

Plojoux

Froudarakis

Janssens

et al. 2019

Clinical Respiratory J

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The pathophysiology and management of primary spontaneous pneumothorax (PSP) are a subject of debate. Despite advances in the understanding of its etiopathogenesis and improvements in its management, implementation in clinical practice is suboptimal. In this manuscript, we review the recent literature with a focus on PSP pathophysiology and management. Blebs and emphysema‐like changes (ELC) are thought to contribute to the pathophysiology of PSP but cannot explain all cases. Recent studies emphasize the role of a diffuse porosity of the visceral pleura. Others found a relationship between smoking, occurrence of a PSP and bronchiolitis, which could be the initial pathological process leading to ELC development. Recent or ongoing studies challenge the need to systematically remove air from the pleural cavity of stable patients, introducing conservative management as a valuable therapeutic option. Evidence is growing in favour of needle aspiration instead of chest tube insertion, when air evacuation is needed. In addition, ambulatory management is considered as a successful approach in meta‐analyses and is under exploration in a large randomized study. Because of a high recurrence rate of PSP, the benefit of performing a pleurodesis at first occurrence is under evaluation with interesting but not generalizable results. Better identification of ‘at risk patients’ is needed to improve the investigation strategy. Finally, recent publications confirm the efficacy, security and cost‐effectiveness of graded talc poudrage pleurodesis to prevent PSP recurrence. In conclusion, PSP pathophysiology and management are still under investigation. The results of recently published and ongoing studies should be more widely implemented in clinical practice.

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Section: In Case Of a First Episode Of Psp Is It Indicated To Performentioning

confidence: 96%

New insights and improved strategies for the management of primary spontaneous pneumothorax

Plojoux

Froudarakis

Janssens

et al. 2019

Clinical Respiratory J

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“…Still, there is no globally-accepted risk stratification system for PSP to determine high-risk patients who would benefit from VATS rather than conservative treatment at initial presentation [5]. Recently, a randomized controlled trial (RCT) showed a positive correlation between the risk of recurrence and the size of bullae based on high-resolution computed tomography (HRCT) [6]. However, the data remain insufficient.…”

Section: Introductionmentioning

confidence: 99%

Do Blebs or Bullae on High-Resolution Computed Tomography Predict Ipsilateral Recurrence in Young Patients at the First Episode of Primary Spontaneous Pneumothorax?

Park

Jang

Song

et al. 2019

Korean J Thorac Cardiovasc Surg

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Background The relationship between the size of bullae and pneumothorax recurrence is controversial. The aim of this study was to retrospectively evaluate the role of blebs or bullae in predicting ipsilateral recurrence in young patients experiencing their first episode of primary spontaneous pneumothorax (PSP) who underwent conservative treatment. Methods A total of 299 cases of first-episode PSP were analyzed. The status of blebs or bullae was reviewed on high-resolution computed tomography (HRCT). The dystrophic severity score (DSS; range, 0 to 6 points) was calculated based on HRCT. Results The 5-year recurrence rate was 38.2%. In univariate analysis, age (<20 years), body mass index (<20 kg/m 2 ), a unilateral lesion, and intermediate risk (DSS 4 and 5) were associated with recurrence. Sex; smoking history; and the presence, number, and maximal size of blebs or bullae were not related to recurrence. In Cox regression, age and intermediate risk were independent risk factors for recurrence. High risk (DDS 6) was not an independent risk factor. Conclusion The presence, number, and size of blebs or bullae did not affect ipsilateral recurrence. DSS failed to show a positive correlation between severity and recurrence. The decision to perform surgery in patients experiencing their first episode of PSP should not be determined by the severity of blebs and bullae.

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“…Les patients des deux groupes ont été traité soit par drainage thoracique soit par chirurgie thoracique vidéo-assistée après la randomisation. Pour les patients qui ont bénéficié d’un drainage thoracique, ceux avec des bulles dont la taille était supérieure ou égale à 2cm étaient à plus haut risque de récidive du PSP (rapport des risques=4.4; 95% intervalle de confiance, 1.04-18.83; p=0.03) [ 9 ]. Ainsi, les constations scanographiques d’un patient présentant un premier épisode de PSP peut avoir des implications thérapeutiques avec une réduction significative du risque de récidive.…”

Section: Discussionunclassified

“…Dans un essai randomisé contrôlé, le score DSS a été calculé par rapport au côté du PSP (score DSS homolatéral maximum à 5). Ce score modifié n'était pas associé à un risque de récidive plus élevé contrairement à la taille des bulles [ 9 ]. Dans deux autres études prospectives incluant respectivement 35 et 55 patients, le nombre, la taille, et la distribution des bulles n'étaient pas corrélés à la récurrence du PSP [ 14 , 15 ].…”

Section: Discussionunclassified

“…De ce fait, l’appréciation de ce risque de récidive impliquant une décision thérapeutique constitue un enjeu capital. Ainsi, l’introduction de score scanographique pour apprécier le risque de récidive d’un PSP après un premier épisode et guider les choix thérapeutiques parait nécessaire [ 9 , 10 ]. Le score DSS ou Dystrophy Severity Score est un outil simple permettant la stratification des patients selon le niveau de risque de récidive [ 9 , 10 ].…”

Section: Introductionunclassified

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Score de prédiction de récidive après un premier épisode de pneumothorax spontané primitif

Saad¹,

Migaou²,

Ammar³

et al. 2020

PAMJ

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Introduction la relation entre les constatations scanographiques et le risque de récidive d’un pneumothorax spontané primitif (PSP) reste conflictuelle. L’objectif de cette étude est de déterminer la relation entre le score scanographique DSS (Dystrophy Severity Score) et la survenue de récidive du PSP après un premier épisode. Méthodes il s’agit d’une étude rétrospective incluant les patients hospitalisés pour un premier épisode de PSP entre 2005-2017. Nous avons reparti notre population en 2 groupes, G1: récidive du PSP, G2: absence de récidive. Nous avons procédé à une analyse uni varié incluant différentes variables dont le score DSS suivie d’une analyse multi variée. Résultats quatre-vingt-six patients ont été inclus dans cette étude. Quarante-huit pourcent des cas ont eu une récidive du PSP. Bien que le score DSS soit significativement associé à la survenue de récidive du PSP (p=0.008), l'analyse multi variée montre que la présence de bulles à la tomodensitométrie thoracique est le facteur de risque indépendant associé à la récidive du PSP après un premier épisode (rapport des risques: 3.26, p< 0.008). Conclusion le risque de récidive d’un PSP est significativement associé à la présence de bulles au scanner thoracique. D’autres études sont nécessaires pour une meilleure appréciation du score DSS.

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Surgical treatment versus conventional chest tube drainage in primary spontaneous pneumothorax: a randomized controlled trial†

Abstract: ClinicalTrial.gov: NCT 02866305.

Cited by 64 publications

References 24 publications

New insights and improved strategies for the management of primary spontaneous pneumothorax

New insights and improved strategies for the management of primary spontaneous pneumothorax

Do Blebs or Bullae on High-Resolution Computed Tomography Predict Ipsilateral Recurrence in Young Patients at the First Episode of Primary Spontaneous Pneumothorax?

Score de prédiction de récidive après un premier épisode de pneumothorax spontané primitif

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