Video-Assisted Thoracoscopic Surgery for the Treatment of First-Time Spontaneous Pneumothorax versus Conservative Treatment

Al-Mourgi, Majed; Alshehri, Fahad

doi:10.12816/0031232

Cited by 12 publications

(20 citation statements)

References 20 publications

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“…This coincides with the classical rate of recurrence of 20-60% (13). Several studies (14,15) have chosen to treat patients with spontaneous pneumothorax with upfront thoracoscopic blebectomy/ bullectomy and/or pleural abrasion/pleurectomy without inserting a chest drain. This practice is well established in patients with recurrent spontaneous pneumothorax or patients at considerable risk like patients with occupational hazards (divers, pilots etc.).…”

Section: Editorialsupporting

confidence: 58%

Is chest tube drainage losing ground in management of patients with spontaneous pneumothorax?

Elsayed

2017

J. Thorac. Dis.

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Section: Editorialsupporting

confidence: 58%

Is chest tube drainage losing ground in management of patients with spontaneous pneumothorax?

Elsayed

2017

J. Thorac. Dis.

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“…Clinical study AL-ALAWI [17] AL-MOURGI [18] ANDERSEN [19] CASALI [10] CHAN [12] CHEN [20] CHEN [21] CHEN [22] GANESALINGAM [9] HARVEY [23] KARASAKI [25] KIM [26] KUAN [27] LICHTER [28] LIGHT [29] MARTÍNEZ-RAMOS [30] MEHTA [31] NISHIUMA [32] NOH [33] NOH [34] OLESEN [6] OUANES-BESBES [13] PRIMAVESI [8] SADIKOT [ due to nutritional deficiencies affecting α 1 -antitrypsin levels or due to unbalanced physical development, was supported by two papers [5,6,[44][45][46].…”

Section: Discussionmentioning

confidence: 99%

Recurrence rates in primary spontaneous pneumothorax: a systematic review and meta-analysis

et al. 2018

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Primary spontaneous pneumothorax (PSP) recurrence rates vary widely in the published literature, with limited data describing the factors that influence recurrence. The aims of this systematic review were to determine an estimation of PSP recurrence rates and describe risk factors for recurrence.A systematic review was conducted of all studies reporting PSP recurrence. Electronic searches were performed to identify English language publications of randomised trials and observational studies. The population was adults with PSP, who underwent conservative management, pleural aspiration or chest drainage. The outcome of interest was recurrence. Articles were screened and data extracted from eligible studies by two reviewers.Of 3607 identified studies, 29 were eligible for inclusion, comprising 13 548 patients. Pooled 1-year and overall recurrence rates were 29.0% (95% CI 20.9-37.0%) and 32.1% (95% CI 27.0-37.2%), respectively. Female sex was associated with increased recurrence (OR 3.03, 95% CI 1.24-7.41), while smoking cessation was associated with a four-fold decrease in risk (OR 0.26, 95% CI 0.10-0.63). for random effects meta-analysis was 94% (p<0.0001), reflecting high heterogeneity between studies.This systematic review demonstrates a 32% PSP recurrence rate, with greatest risk in the first year. Female sex was associated with higher risk, suggesting possible sex-specific pathophysiology.

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“…68 There have now been two RCTs of early VATS compared to conservative management after first PSP: the first by Al-Mourgi and Alshehri 69 was a small trial of 41 patients, in which the VATS group underwent surgery within 24 hours of admission to hospital compared to "conservative" treatment with chest tube drainage. 69 They found no recurrence (0%) in the VATS group, compared to 40.9% in the conservative group, which is higher than previously reported. 29,30 The second larger RCT by Olesen et al 70 enrolled 373 PSP patients again showed a significant lower recurrence rate in those treated with VATS (13%) compared to conservative treatment (34%).…”

Section: Recurrence Prevention After First Occurrence?mentioning

confidence: 63%

Pneumothorax—Time for New Guidelines?

Hallifax

Janssen

2019

Semin Respir Crit Care Med

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Pneumothorax is a common pathology, but optimal management strategies are not yet defined. There are significant differences in international guidelines and therefore variation in clinical practice.There is increasing interest in pneumothorax research, particularly primary spontaneous pneumothorax (PSP), with evidence of lung abnormalities in this group without clinically apparent lung disease and recently completed clinical trials aiming to optimize management. The most robust evidence base is that of the equivalence of needle aspiration and chest tube insertion for initial management of PSP; although, patients with secondary spontaneous pneumothorax may also benefit. A convincing case for surgical intervention or thoracoscopy and talc poudrage to prevent recurrence at first episode in PSP has yet to be made. Clinicians should be vigilant for PSP being the first manifestation of a systemic disease, and should have a low threshold for onward referral. Time to change guidelines? First, chest tube drainage and hospitalization without recurrence prevention should no longer be standard treatment, as this has no advantage over the less invasive manual aspiration, which moreover can be performed on an outpatient basis in an important number of patients. The results of recent trials in conservative and ambulatory management are eagerly awaited. Second, shared decision-making should become more important with the well-informed patient, who may want to avoid a 1 in 3 recurrence rate and therefore will have the possibility to choose treatment including recurrence prevention even after the first episode of PSP. Third, surgical research should urgently make clear if the current practice of resection of emphysema-like changes is routinely necessary, alongside pleurodesis. Future studies should utilize risk stratification by clinical and radiological parameters (e.g., high-resolution computed tomography scanning and digital air leak monitoring) to predict short- and long-term outcomes, and hence personalize management.

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Video-Assisted Thoracoscopic Surgery for the Treatment of First-Time Spontaneous Pneumothorax versus Conservative Treatment

Cited by 12 publications

References 20 publications

Is chest tube drainage losing ground in management of patients with spontaneous pneumothorax?

Is chest tube drainage losing ground in management of patients with spontaneous pneumothorax?

Recurrence rates in primary spontaneous pneumothorax: a systematic review and meta-analysis

Pneumothorax—Time for New Guidelines?

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