1
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Walker S, Hallifax R, Ricciardi S, Fitzgerald D, Keijzers M, Lauk O, Petersen J, Bertolaccini L, Bodtger U, Clive A, Elia S, Froudarakis M, Janssen J, Lee YCG, Licht P, Massard G, Nagavci B, Neudecker J, Roessner E, Van Schil P, Waller D, Walles T, Cardillo G, Maskell N, Rahman N. Joint ERS/EACTS/ESTS clinical practice guidelines on adults with spontaneous pneumothorax. Eur J Cardiothorac Surg 2024; 65:ezae189. [PMID: 38804185 DOI: 10.1093/ejcts/ezae189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 02/09/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVES The optimal management for spontaneous pneumothorax (SP) remains contentious, with various proposed approaches. This joint clinical practice guideline from the ERS, EACTS and ESTS societies provides evidence-based recommendations for the management of SP. METHODS This multidisciplinary Task Force addressed 12 key clinical questions on the management of pneumothorax, using ERS methodology for guideline development. Systematic searches were performed in MEDLINE and Embase. Evidence was synthesised by conducting meta-analyses, if possible, or narratively. Certainty of evidence was rated with GRADE (Grading, Recommendation, Assessment, Development and Evaluation). The Evidence to Decision framework was used to decide on the direction and strength of the recommendations. RESULTS The panel makes a conditional recommendation for conservative care of minimally symptomatic patients with primary spontaneous pneumothorax (PSP) who are clinically stable. We make a strong recommendation for needle aspiration over chest tube drain for initial PSP treatment. We make a conditional recommendation for ambulatory management for initial PSP treatment. We make a conditional recommendation for early surgical intervention for the initial treatment of PSP in patients who prioritise recurrence prevention. The panel makes a conditional recommendation for autologous blood patch in secondary SP patients with persistent air leak (PAL). The panel could not make recommendations for other interventions, including bronchial valves, suction, pleurodesis in addition to surgical resection or type of surgical pleurodesis. CONCLUSIONS With this international guideline, the ERS, EACTS and ESTS societies provide clinical practice recommendations for SP management. We highlight evidence gaps for the management of PAL and recurrence prevention, with research recommendations made. SHAREABLE ABSTRACT This update of an ERS Task Force statement from 2015 provides a concise comprehensive update of the literature base. 24 evidence-based recommendations were made for management of pneumothorax, balancing clinical priorities and patient views.https://bit.ly/3TKGp9e.
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Affiliation(s)
- Steven Walker
- Academic Respiratory Unit, Southmead Hospital, Bristol, UK
- Junior Chair of the Task Force
| | - Robert Hallifax
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Sara Ricciardi
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
- Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Deirdre Fitzgerald
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- Medical School and Centre for Respiratory Health, University of Western Australia, Perth, Australia
| | - Marlies Keijzers
- Department of Surgery, Maxima Medical Center, Veldhoven, Netherlands
| | - Olivia Lauk
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Jesper Petersen
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine Zealand, University Hospital, Naestved, Denmark
| | - Luca Bertolaccini
- Division of Thoracic Surgery IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Uffe Bodtger
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine Zealand, University Hospital, Naestved, Denmark
| | - Amelia Clive
- North Bristol Lung Centre, Southmead Hospital, Bristol, UK
| | - Stefano Elia
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
- Thoracic Surgical Oncology Programme, Tor Vergata University Hospital, Rome, Italy
| | - Marios Froudarakis
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece
- Medical School, University Jean Monnet, Saint Etienne, France
| | - Julius Janssen
- Department of Pulmonology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Y C Gary Lee
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- Medical School and Centre for Respiratory Health, University of Western Australia, Perth, Australia
| | - Peter Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Gilbert Massard
- Department of Thoracic Surgery, University of Luxembourg, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - Blin Nagavci
- Institute for Evidence in Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Jens Neudecker
- Competence Center for Thoracic Surgery, Charité - Universitätsmedizin, Berlin, Germany
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Berlin, Germany
| | - Eric Roessner
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - David Waller
- Thorax Centre, St Bartholomew's Hospital, London, UK
| | - Thorsten Walles
- Clinic for Cardiac and Thoracic Surgery, Magdeburg University Hospital, Magdeburg, Germany
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
- Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Unicamillus-International University of Health Sciences, Rome, Italy
- Senior Chairs of the Task Force
| | - Nick Maskell
- Academic Respiratory Unit, Southmead Hospital, Bristol, UK
- North Bristol Lung Centre, Southmead Hospital, Bristol, UK
- Senior Chairs of the Task Force
| | - Najib Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Chinese Academy of Medical Sciences Oxford Institute, Oxford, UK
- Senior Chairs of the Task Force
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Walker S, Hallifax R, Ricciardi S, Fitzgerald D, Keijzers M, Lauk O, Petersen J, Bertolaccini L, Bodtger U, Clive A, Elia S, Froudarakis M, Janssen J, Lee YCG, Licht P, Massard G, Nagavci B, Neudecker J, Roessner E, Van Schil P, Waller D, Walles T, Cardillo G, Maskell N, Rahman N. Joint ERS/EACTS/ESTS clinical practice guidelines on adults with spontaneous pneumothorax. Eur Respir J 2024; 63:2300797. [PMID: 38806203 DOI: 10.1183/13993003.00797-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 02/09/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND The optimal management for spontaneous pneumothorax (SP) remains contentious, with various proposed approaches. This joint clinical practice guideline from the ERS, EACTS and ESTS societies provides evidence-based recommendations for the management of SP. METHODS This multidisciplinary Task Force addressed 12 key clinical questions on the management of pneumothorax, using ERS methodology for guideline development. Systematic searches were performed in MEDLINE and Embase. Evidence was synthesised by conducting meta-analyses, if possible, or narratively. Certainty of evidence was rated with GRADE (Grading of Recommendations, Assessment, Development and Evaluations). The Evidence to Decision framework was used to decide on the direction and strength of the recommendations. RESULTS The panel makes a conditional recommendation for conservative care of minimally symptomatic patients with primary spontaneous pneumothorax (PSP) who are clinically stable. We make a strong recommendation for needle aspiration over chest tube drain for initial PSP treatment. We make a conditional recommendation for ambulatory management for initial PSP treatment. We make a conditional recommendation for early surgical intervention for the initial treatment of PSP in patients who prioritise recurrence prevention. The panel makes a conditional recommendation for autologous blood patch in secondary SP patients with persistent air leak (PAL). The panel could not make recommendations for other interventions, including bronchial valves, suction, pleurodesis in addition to surgical resection or type of surgical pleurodesis. CONCLUSIONS With this international guideline, the ERS, EACTS and ESTS societies provide clinical practice recommendations for SP management. We highlight evidence gaps for the management of PAL and recurrence prevention, with research recommendations made.
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Affiliation(s)
- Steven Walker
- Academic Respiratory Unit, Southmead Hospital, Bristol, UK
- Junior Chair of the Task Force
| | - Robert Hallifax
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Sara Ricciardi
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
- Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Deirdre Fitzgerald
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- Medical School and Centre for Respiratory Health, University of Western Australia, Perth, Australia
| | - Marlies Keijzers
- Department of Surgery, Maxima Medical Center, Veldhoven, The Netherlands
| | - Olivia Lauk
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Jesper Petersen
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine Zealand, University Hospital, Naestved, Denmark
| | - Luca Bertolaccini
- Division of Thoracic Surgery IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Uffe Bodtger
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine Zealand, University Hospital, Naestved, Denmark
| | - Amelia Clive
- North Bristol Lung Centre, Southmead Hospital, Bristol, UK
| | - Stefano Elia
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
- Thoracic Surgical Oncology Programme, Tor Vergata University Hospital, Rome, Italy
| | - Marios Froudarakis
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece
- Medical School, University Jean Monnet, Saint Etienne, France
| | - Julius Janssen
- Department of Pulmonology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Y C Gary Lee
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- Medical School and Centre for Respiratory Health, University of Western Australia, Perth, Australia
| | - Peter Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Gilbert Massard
- Department of Thoracic Surgery, University of Luxembourg, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - Blin Nagavci
- Institute for Evidence in Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Jens Neudecker
- Competence Center for Thoracic Surgery, Charité - Universitätsmedizin, Berlin, Germany
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Berlin, Germany
| | - Eric Roessner
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - David Waller
- Thorax Centre, St Bartholomew's Hospital, London, UK
| | - Thorsten Walles
- Clinic for Cardiac and Thoracic Surgery, Magdeburg University Hospital, Magdeburg, Germany
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
- Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Unicamillus - International University of Health Sciences, Rome, Italy
- Senior Chairs of the Task Force
| | - Nick Maskell
- Academic Respiratory Unit, Southmead Hospital, Bristol, UK
- North Bristol Lung Centre, Southmead Hospital, Bristol, UK
- Senior Chairs of the Task Force
| | - Najib Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Chinese Academy of Medical Sciences Oxford Institute, Oxford, UK
- Senior Chairs of the Task Force
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Furuta C, Yano M, Kitagawa Y, Katsuya R, Ozeki N, Fukui T. Prospective Observation Study for Primary Spontaneous Pneumothorax: Incidence of and Risk Factors for Postoperative Neogenesis of Bullae. Ann Thorac Cardiovasc Surg 2024; 30:23-00206. [PMID: 38599823 PMCID: PMC11082493 DOI: 10.5761/atcs.oa.23-00206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/16/2024] [Indexed: 04/12/2024] Open
Abstract
PURPOSE Details of the neogenesis of bullae (NOB), which causes recurrent primary spontaneous pneumothorax (PSP) following bullectomy, have not been reported and risk factors for NOB remain unclear. We aimed to clarify the details of NOB. METHODS We conducted a prospective study using three computed tomography (CT) examinations performed 6, 12, and 24 months after bullectomy to identify the incidence of and risk factors for NOB. We enrolled 50 patients who underwent bullectomy for PSP. RESULTS After excluding 11 patients who canceled the postoperative CT examination at 6 months after bullectomy, only 39 patients were analyzed. The incidence of NOB at 6, 12, and 24 months after bullectomy was 38.5%, 55.2%, and 71.2%, respectively. The rate of NOB in the operated lung was almost 2 times higher than that in the contralateral nonoperative lung. Male sex, multiple bullae on preoperative CT, long stapling line (≥7 cm), deep stapling depth (≥1.5 cm), and heavier resected sample (≥5 g) were suggested to be risk factors for NOB. CONCLUSIONS We recognized a high incidence of postoperative NOB in PSP patients. Bullectomy itself seems to promote NOB. Postoperative NOB occurs frequently, especially in patients who require a large-volume lung resection with a long staple line.
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Affiliation(s)
- Chihiro Furuta
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Motoki Yano
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Yuka Kitagawa
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Ryotaro Katsuya
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Naoki Ozeki
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Takayuki Fukui
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Aichi, Japan
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Kennedy N, Petrakis N, Chan J, Jurisevic C. Spontaneous pneumothorax rates following video-assisted thoracoscopic talc pleurodesis with or without resection of macroscopic bullous disease. ANZ J Surg 2023; 93:2402-2405. [PMID: 37332259 DOI: 10.1111/ans.18552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/23/2023] [Accepted: 05/20/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Recurrent primary spontaneous pneumothorax (PSP) is routinely treated by video-assisted thoracoscopic (VATS) talc pleurodesis (with or without localized resection of macroscopic bullous disease). There is a paucity of published data regarding durability of the procedure and the rate of recurrent pneumothorax after such surgery, and this has significant implications from a prognostic and employment limitation perspective. METHODS Patients who underwent a VATS talc pleurodesis (with or without localized resection of macroscopic bullous disease) for the treatment of their second or subsequent PSP or a PSP were followed for recurrent ipsilateral pneumothorax and new contralateral PSP. Follow up was by way of telephone interview and medical record verification out to 48 months. RESULTS New contralateral pneumothorax occurred in 7 patients (11.1%) in the talc pleurodesis plus wedge resection group and 2 (1.8%) in the talc pleurodesis only group. There was one case of recurrent ipsilateral pneumothorax in a patient who had no inflammatory response to talc insufflation. CONCLUSION Video-assisted thoracoscopic (VATS) talc pleurodesis (and lung resection for macroscopic bullous disease) is a durable treatment for recurrent PSP. Patients with macroscopic disease have a significant risk of subsequent contralateral PSP.
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Affiliation(s)
- Nicholas Kennedy
- Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Nicholas Petrakis
- Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Justin Chan
- Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Craig Jurisevic
- Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Speck KE, Kulaylat AN, Baerg JE, Acker SN, Baird R, Beres AL, Chang H, Derderian SC, Englum B, Gonzalez KW, Kawaguchi A, Kelley-Quon L, Levene TL, Rentea RM, Rialon KL, Ricca R, Somme S, Wakeman D, Yousef Y, St Peter SD, Lucas DJ. Evaluation and Management of Primary Spontaneous Pneumothorax in Adolescents and Young Adults: A Systematic Review From the APSA Outcomes & Evidence-Based Practice Committee. J Pediatr Surg 2023; 58:1873-1885. [PMID: 37130765 DOI: 10.1016/j.jpedsurg.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/15/2023] [Accepted: 03/31/2023] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Controversy exists in the optimal management of adolescent and young adult primary spontaneous pneumothorax. The American Pediatric Surgical Association (APSA) Outcomes and Evidence-Based Practice Committee performed a systematic review of the literature to develop evidence-based recommendations. METHODS Ovid MEDLINE, Elsevier Embase, EBSCOhost CINAHL, Elsevier Scopus, and Wiley Cochrane Central Register of Controlled Trials databases were queried for literature related to spontaneous pneumothorax between January 1, 1990, and December 31, 2020, addressing (1) initial management, (2) advanced imaging, (3) timing of surgery, (4) operative technique, (5) management of contralateral side, and (6) management of recurrence. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed. RESULTS Seventy-nine manuscripts were included. Initial management of adolescent and young adult primary spontaneous pneumothorax should be guided by symptoms and can include observation, aspiration, or tube thoracostomy. There is no evidence of benefit for cross-sectional imaging. Patients with ongoing air leak may benefit from early operative intervention within 24-48 h. A video-assisted thoracoscopic surgery (VATS) approach with stapled blebectomy and pleural procedure should be considered. There is no evidence to support prophylactic management of the contralateral side. Recurrence after VATS can be treated with repeat VATS with intensification of pleural treatment. CONCLUSIONS The management of adolescent and young adult primary spontaneous pneumothorax is varied. Best practices exist to optimize some aspects of care. Further prospective studies are needed to better determine optimal timing of operative intervention, the most effective operation, and management of recurrence after observation, tube thoracostomy, or operative intervention. LEVEL OF EVIDENCE Level 4. TYPE OF STUDY Systematic Review of Level 1-4 studies.
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Affiliation(s)
- K Elizabeth Speck
- Mott Children's Hospital, University of Michigan, Division of Pediatric Surgery, Ann Arbor, MI, USA.
| | - Afif N Kulaylat
- Penn State Children's Hospital, Division of Pediatric Surgery, Hershey, PA, USA
| | - Joanne E Baerg
- Presbyterian Health Services, Division of Pediatric Surgery, Albuquerque, NM, USA
| | | | - Robert Baird
- British Columbia Children's Hospital, Vancouver, Canada
| | - Alana L Beres
- St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Henry Chang
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | | | - Brian Englum
- University of Maryland Children's Hospital, Baltimore, MD, USA
| | | | | | | | | | - Rebecca M Rentea
- Children's Mercy-Kansas City, Department of Surgery, Kansas City, MO, USA
| | | | - Robert Ricca
- University of South Carolina, Greenville, SC, USA
| | - Stig Somme
- Children's Hospital Colorado, Aurora, CO, USA
| | | | - Yasmine Yousef
- Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Shawn D St Peter
- Children's Mercy-Kansas City, Department of Surgery, Kansas City, MO, USA
| | - Donald J Lucas
- Division of Pediatric Surgery, Naval Medical Center San Diego, CA, USA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Çıtak N, Özdemir S, Köse S. Could the probability of surgical indication be determined after first episode of primary spontaneous pneumothorax? Gen Thorac Cardiovasc Surg 2023:10.1007/s11748-023-01913-y. [PMID: 36807111 DOI: 10.1007/s11748-023-01913-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/05/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVES To develop a risk score model for primary spontaneous pneumothorax surgery (prolonged air leak or ipsilateral recurrence). The model was internally validated for risk estimation. METHODS We analyzed 453 patients with primary spontaneous pneumothorax between 2014 and 2018. Patients were randomly assigned a 2:1 ratio to the development dataset (n = 302, study cohort) or the internal validation dataset (n = 151, validation cohort). The final outcomes of patients with primary spontaneous pneumothorax, the presence or absence of surgical indications, were tracked. Multivariable logistic regression models were prepared to estimate the probability of surgical indication and a scoring model was created. It was internally validated using the validation cohort. Calibration was ascertained using the Hosmer-Lemeshow method and Brier score. RESULTS The surgery indication rate was 47.8% (n = 217) (prolonged air leak, n = 130; ipsilateral recurrence, n = 87). There were no demographic or radiological differences between the validation and the study cohorts. Logistic regression analysis showed that the presence of bullae or blebs (p < 0.001, odds ratio = 3.340, 95%CI = 1.753-6.363) and pneumothorax volume (p < 0.001, odds ratio = 1.033, 95%CI = 1.019-1.048) were independent risk factors for surgical indication. The scoring model significantly predicted surgical indications (area under the curve, AUC = 0.768, 95%CI = 0.714-0.821, p < 0.001). Our model showed acceptable discrimination with an AUC > 0.75 in the validation set (AUC = 0.777, 95%CI = 0.702-0.852, p < 0.001) and had an adequate calibration (Hosmer-Lemeshow test p = 0.249, Brier score = 0.25). CONCLUSION The internally validated primary spontaneous pneumothorax scoring model was a good predictor of the need for surgery in patients with primary spontaneous pneumothorax. Prospective external validation studies with larger patient cohorts are required.
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Affiliation(s)
- Necati Çıtak
- Thoracic Surgery Department, Bakirköy Dr. Sadi Konuk Research and Education Hospital, Istanbul, Turkey.
| | - Servet Özdemir
- Thoracic Surgery Department, Bakirköy Dr. Sadi Konuk Research and Education Hospital, Istanbul, Turkey
| | - Selçuk Köse
- Thoracic Surgery Department, Bakirköy Dr. Sadi Konuk Research and Education Hospital, Istanbul, Turkey
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Jeong JY, Shin AY, Ha JH, Suh JH, Choi SY, Kim JS, Park CB. Natural History of Contralateral Bullae/Blebs After Ipsilateral Video-Assisted Thoracoscopic Surgery for Primary Spontaneous Pneumothorax: A Retrospective Cohort Study. Chest 2022; 162:1213-1222. [PMID: 35562058 DOI: 10.1016/j.chest.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/02/2022] [Accepted: 05/02/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Contralateral bullae/blebs are frequently found in patients who are scheduled to undergo ipsilateral video-assisted thoracoscopic surgery (VATS) for primary spontaneous pneumothorax (PSP). RESEARCH QUESTION Should visible contralateral bullae/blebs be simultaneously resected when ipsilateral VATS bullectomy is performed? STUDY DESIGN AND METHODS In this single-center, retrospective cohort study, we included patients aged ≤ 30 years who underwent ipsilateral VATS for PSP from April 2009 to December 2019. Electronic medical records, radiograph images, and preoperative high-resolution CT images were reviewed. The primary end point was recurrence-free survival (no contralateral pneumothorax) after discharge of ipsilateral VATS for PSP, determined via Kaplan-Meier analysis. Recurrence was compared between the group with and that without contralateral bullae/blebs by using the log-rank test. A multivariable Cox proportional hazards model was constructed to investigate risk factors for contralateral pneumothorax. RESULTS Among 567 patients, contralateral pneumothorax occurred in 86 of them after ipsilateral VATS (15.2%) during a median follow-up period of 51.3 (interquartile range, 67.2) months. The 1-, 5-, and 10-year recurrence-free survival rates were 92.2%, 83.7%, and 79.9%, respectively. Contralateral recurrence was higher in the group with (82/455, 18.0%) than in that without (4/112, 3.6%) contralateral bullae/blebs (P < .001). Age (hazard ratio [HR], 0.701; 95% CI, 0.629-0.780; P < .001), current smoking (HR, 2.106; 95% CI, 1.158-3.831; P = .015), and the presence of bullae/blebs (increasing with size, HR, 4.818-8.980; all P < .05) were independent risk factors for contralateral pneumothorax. The annual rates of contralateral pneumothorax in the group with (4.0%) and in that without (0.7%) contralateral bullae/blebs declined over time. INTERPRETATION Although contralateral bullae/blebs were common in patients who underwent ipsilateral VATS for PSP and were statistically significantly associated with future pneumothorax, the annual rate of pneumothorax was 4.0% in such patients, and it decreased over time. Therefore, a conservative approach on unruptured contralateral bullae/blebs is recommended.
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Affiliation(s)
- Jin Yong Jeong
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ah Young Shin
- Division of Pulmonology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jick Hwan Ha
- Division of Pulmonology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Hui Suh
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Si Young Choi
- Department of Thoracic and Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ju Sang Kim
- Division of Pulmonology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chan Beom Park
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Girish M, Pharoah PD, Marciniak SJ. Meta-analysis of the association between emphysematous change on thoracic computerized tomography scan and recurrent pneumothorax. QJM 2022; 115:215-221. [PMID: 33538832 PMCID: PMC9020478 DOI: 10.1093/qjmed/hcab020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/19/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES At least a third of patients go on to suffer a recurrence following a first spontaneous pneumothorax. Surgical intervention reduces the risk of recurrence and has been advocated as a primary treatment for pneumothorax. But surgery exposes patients to the risks of anaesthesia and in some cases can cause chronic pain. Risk stratification of patients to identify those most at risk of recurrence would help direct the most appropriate patients to early intervention. Many studies have addressed the role of thoracic computerized tomography (CT) in identifying those individuals at increased risk of recurrence, but a consensus is lacking. AIM Our objective was to clarify whether CT provides valuable prognostic information for recurrent pneumothorax. DESIGN Meta-analysis. METHODS We conducted an exhaustive search of the literature for thoracic CT imaging and pneumothorax, and then performed a meta-analysis using a random effects model to estimate the common odds ratio and standard error. RESULTS Here, we show by meta-analysis of data from 2475 individuals that emphysematous change on CT scan is associated with a significant increased odds ratio for recurrent pneumothorax ipsilateral to the radiological abnormality (odds ratio 2.49, 95% confidence interval 1.51-4.13). CONCLUSIONS The association holds true for primary spontaneous pneumothorax when considering emphysematous changes including blebs and bullae. Features, such as bullae at the azygoesophageal recess or increased Goddard score similarly predicted recurrent secondary pneumothorax, as shown by subgroup analysis. Our meta-analysis suggests that CT scanning has value in risk stratifying patients considering surgery for pneumothorax.
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Affiliation(s)
- M Girish
- From the Department of Respiratory Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 0SP, UK
- Department of Respiratory Medicine, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK
| | - P D Pharoah
- Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
| | - S J Marciniak
- From the Department of Respiratory Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 0SP, UK
- Department of Respiratory Medicine, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK
- Cambridge Institute for Medical Research (CIMR), University of Cambridge, Hills Road, Cambridge CB2 0XY, UK
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9
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Shigefuku S, Takahashi H, Ito M, Kajiwara N, Ohira T, Ikeda N. Significance of very-low-voltage coagulation plus coverage with polyglycolic acid sheet after bullectomy for primary spontaneous pneumothorax. Asian Cardiovasc Thorac Ann 2022; 30:2184923211072595. [PMID: 35040360 DOI: 10.1177/02184923211072595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this study was to clarify the efficacy of the combination of low-voltage coagulation plus staple line coverage with a polyglycolic acid sheet after bullectomy for primary spontaneous pneumothorax to prevent a postoperative recurrence. METHODS A total of 143 patients who underwent bullectomy for primary spontaneous pneumothorax between January 2014 and December 2019 were enrolled in this study. We classified the patients into two groups based on additional procedures after bullectomy, namely, low-voltage coagulation for the margin of the staple line plus coverage with a polyglycolic acid sheet (Group A) and staple line coverage with a polyglycolic acid sheet alone (Group B). We evaluated perioperative factors and recurrence-free survival after surgery in the two groups. RESULTS Nine patients in Group B developed postoperative recurrences. In contrast, there was no postoperative recurrence in Group A. According to the Kaplan-Meier curves, the 2-year recurrence-free survival rates of the patients were 100% and 90.3%, in Group A and Group B, respectively. The log-rank test showed a significant difference between the two groups (p = 0.031). CONCLUSION Low-voltage coagulation for the margin of a staple line plus coverage with a polyglycolic acid sheet is a useful option as an additional technique after bullectomy for primary spontaneous pneumothorax to prevent a postoperative recurrence.
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Affiliation(s)
- Shunsuke Shigefuku
- Department of Surgery, 89440Hachioji Medical Center of Tokyo Medical University, Tokyo, Japan
| | - Hidenobu Takahashi
- Department of Surgery, 89440Hachioji Medical Center of Tokyo Medical University, Tokyo, Japan
| | - Maki Ito
- Department of Surgery, 89440Hachioji Medical Center of Tokyo Medical University, Tokyo, Japan
| | - Naohiro Kajiwara
- Department of Surgery, 89440Hachioji Medical Center of Tokyo Medical University, Tokyo, Japan
| | - Tatsuo Ohira
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
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10
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Özdemir S, Çitak N. Determination of Risk Factors for Recurrence in First Episode Pneumothorax. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03274-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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11
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Azam A, Zahid A, Abdullah Q, Qayyum N, Abdelmoteleb M, Ganaie MB. Utility of thoracic computed tomography to predict need for early surgery and recurrence after first episode of primary spontaneous pneumothorax. Clin Med (Lond) 2021; 22:71-74. [PMID: 34893502 DOI: 10.7861/clinmed.2021-0074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION CT imaging is not advocated by British Thoracic Society guidelines after first episode of primary spontaneous pneumothorax (PSP). There is emerging evidence that emphysema-like changes and CT-based dystrophy severity score (DSS) can predict need for early surgery and recurrence. OBJECTIVES We aimed to assess the role of DSS during first episodes of PSP in predicting the need for early surgery and recurrence. METHODS We conducted a retrospective analysis of consecutive PSP episodes (n=197) admitted to our institution from 1 January 2012 to 31 December 2017. DSS was calculated based on type, number and distribution of blebs and bullae. Patients were categorised as low-grade (0-3) or high-grade (4-6) DSS assessed by a thoracic radiologist. RESULTS Forty-five PSP patients had CT at first presentation. Eight patients had low-grade DSS; all were managed non-surgically and none had recurrence over 12 months. Thirty-seven patients had high-grade DSS. Of these, 25 (67.5%) were managed surgically, with three having contralateral recurrence over 12 months; 12 (32.5%) were managed non-surgically, and of these two patients had ipsilateral recurrence over 12 months. CONCLUSION DSS seems to predict the need for early surgery and recurrence and CT can be used to risk-stratify patients after a first episode of PSP.
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Affiliation(s)
- Asif Azam
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Ahsan Zahid
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Qaiser Abdullah
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Noman Qayyum
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Mostafa Abdelmoteleb
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Muhammad Badar Ganaie
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
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12
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Namwaing P, Chaisuksant S, Sawadpanich R, Anukunananchai T, Timinkul A, Sakaew W, Sawunyavisuth B, Sukeepaisarnjaroen W, Khamsai S, Sawanyawisuth K. Oxygen saturation associated with recurrent primary spontaneous pneumothorax treated with an intercostal chest drainage. Asian J Surg 2021; 45:431-434. [PMID: 34312054 DOI: 10.1016/j.asjsur.2021.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/12/2021] [Accepted: 07/16/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Primary spontaneous pneumothorax (PSP) is a condition that may lead to acute chest pain or dyspnea on exertion. Treatment with an intercostal chest drainage (ICD) is warranted. There is limited data on risk factors of recurrent PSP in patients treated with the ICD alone. This study aimed to evaluate risk factors of recurrent PSP in patients with PSP and treated with the ICD. METHODS This was a retrospective study and enrolled patients diagnosed as PSP and treated with an ICD. Eligible patients were divided into two groups by evidence of recurrent PSP. Baseline characteristics, physical signs, laboratory results, and duration of ICD treatment were studied and recorded from medical charts. Factors associated with recurrent PSP were computed by using multivariate logistic regression analysis. RESULTS There were 80 patients met the study criteria. Of those, 21 patients (26.3%) had recurrent PSP. Of those, 21 patients (26.3%) had recurrent PSP. There were eight factors in the final model for recurrent PSP. Only oxygen saturation at the time of diagnosis was independently associated with recurrent PSP. The adjusted odds ratio (95% confident interval) was 0.57 (0.34, 0.96). A cut point of 96% of oxygen saturation gave sensitivity of recurrent PSP of 80.95%. CONCLUSION The prevalence of recurrent PSP was 26.3% in patients with PSP and treated with the ICD. Initial oxygen saturation may be an indicator for recurrent PSP.
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Affiliation(s)
- Puthachad Namwaing
- Khon Kaen Hospital, Khon Kaen, Thailand; Exercise and Sport Sciences Program, Graduate School, Khon Kaen University, Khon Kaen, Thailand
| | | | | | | | - Akkaranee Timinkul
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Waraporn Sakaew
- Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Bundit Sawunyavisuth
- Department of Marketing, Faculty of Business Administration and Accountancy, Khon Kaen University, Khon Kaen, Thailand
| | | | - Sittichai Khamsai
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
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Kao CN, Chou SH, Tsai MJ, Chang PC, Liu YW. Male adolescents with contralateral blebs undergoing surgery for primary spontaneous pneumothorax may benefit from simultaneous contralateral blebectomies. BMC Pulm Med 2021; 21:210. [PMID: 34217255 PMCID: PMC8255021 DOI: 10.1186/s12890-021-01577-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/29/2021] [Indexed: 12/02/2022] Open
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. The patients were categorized into those with contralateral blebs receiving one-stage bilateral surgeries (32 patients), those with contralateral blebs only receiving unilateral surgeries (40 patients), and those without contralateral blebs only receiving unilateral surgeries (60 patients). Perioperative details and outcomes were retrospectively analyzed. RESULTS Significant differences in contralateral recurrence rate 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, 95% confidence interval [CI] 1.08-7.30, P = 0.034). Moreover, patients who had contralateral blebs and only received unilateral surgery were at greater risk of overall recurrence (HR 6.06, 95% CI 1.77-20.75, 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 blebectomies in those receiving one-stage bilateral surgeries significantly reduced future contralateral recurrence without compromising patient safety.
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Affiliation(s)
- Chieh-Ni Kao
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 80756, Taiwan
| | - Shah-Hwa Chou
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 80756, Taiwan
- Department of Surgery, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Chih Chang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 80756, Taiwan
| | - Yu-Wei Liu
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 80756, Taiwan.
- PhD Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University, National Health Research Institutes, Kaohsiung, Taiwan.
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Jang HJ, Lee JH, Nam SH, Ro SK. Fate of contralateral asymptomatic bullae in patients with primary spontaneous pneumothorax. Eur J Cardiothorac Surg 2021; 58:365-370. [PMID: 32182337 DOI: 10.1093/ejcts/ezaa054] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/20/2020] [Accepted: 01/29/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES This retrospective cohort study aimed to analyse the impact of asymptomatic blebs/bullae on the occurrence of primary spontaneous pneumothorax (PSP) by monitoring the natural course of contralateral blebs/bullae in patients with ipsilateral pneumothorax. METHODS From January 2003 to December 2017, 1055 patients [age 19.6 ± 3.98 years (mean ± standard deviation), 953 men] experiencing the first episode of unilateral PSP were enrolled in this study, excluding patients aged 30 years or more. The presence, number and maximal size of the blebs/bullae were investigated in contralateral asymptomatic lungs based on high-resolution computed tomography. RESULTS Multiple and single blebs/bullae were noted in contralateral lungs in 425 (40.3%) and 88 (8.3%) patients, respectively. The median follow-up period was 44.0 (interquartile range 71.5) months. The 1-, 3- and 5-year cumulative occurrence rates of PSP in contralateral lungs were 7.9%, 13.7% and 16.7%, respectively. On multivariable analysis, younger age [hazard ratio (HR) 1.19, 95% confidence interval (CI) 1.12-1.27; P < 0.001) and multiple bullae (HR 4.42, 95% CI 3.06-6.38; P < 0.001) were independent risk factors for spontaneous pneumothorax in the contralateral lung. The 5-year cumulative occurrence rates of PSP were significantly higher in patients with multiple blebs/bullae than in those with no or a single bleb/bulla (28.2% vs 8.5%, respectively; P < 0.001). CONCLUSIONS Asymptomatic blebs/bullae often lead to PSP. If the patient is eligible for surgery for pneumothorax, preemptive surgery for contralateral bullae could be considered, especially in patients with multiple blebs/bullae.
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Affiliation(s)
- Hyo Jun Jang
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Jun Ho Lee
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Seung Hyuk Nam
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Sun Kyun Ro
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul, Korea
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Wilson PM, Rymeski B, Xu X, Hardie W. An evidence-based review of primary spontaneous pneumothorax in the adolescent population. J Am Coll Emerg Physicians Open 2021; 2:e12449. [PMID: 34179877 PMCID: PMC8212556 DOI: 10.1002/emp2.12449] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 02/03/2023] Open
Abstract
Primary spontaneous pneumothorax (PSP) is a relatively common problem in emergency medicine. The incidence of PSP peaks in adolescence and is most common in tall, thin males. Recent advances in the care of patients with PSP have called into question traditional approaches to management. This clinical review highlights the changing management strategies for PSP and concludes with a proposed evidence-based pathway to guide the care of adolescents with PSP.
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Affiliation(s)
- Paria M. Wilson
- Department of PediatricsUniversity of CincinnatiCollege of MedicineCincinnatiOhioUSA
- Division of Emergency MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Beth Rymeski
- Division of Pediatric SurgeryCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Xuefeng Xu
- Department of RheumatologyImmunology & AllergyRespiratory MedicineThe Children's HospitalZhejiang University School of MedicineNational Clinical Research Center for Child HealthHangzhouChina
| | - William Hardie
- Department of PediatricsUniversity of CincinnatiCollege of MedicineCincinnatiOhioUSA
- Division of Pulmonary MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
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Yalçınkaya İ, Doğruyol MT. Prophylactic Chest Surgery Procedures. PROPHYLACTIC SURGERY 2021:371-378. [DOI: 10.1007/978-3-030-66853-2_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Kim IS, Kim JJ, Han JW, Jeong SC, Kim YH. Conservative treatment for recurrent secondary spontaneous pneumothorax in patients with a long recurrence-free interval. J Thorac Dis 2020; 12:2459-2466. [PMID: 32642152 PMCID: PMC7330374 DOI: 10.21037/jtd.2020.03.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Although recurrence is included in surgical indications, there is no definitive guideline for managing recurrent spontaneous pneumothorax (SP) according to characteristics of recurrence, such as the type [primary SP (PSP) or secondary SP (SSP)] and recurrence-free interval (RFI). Actually, some patients with early cessation of air leak after closed thoracostomy tubes, a long RFI, or medical comorbidities are often managed conservatively without surgery. However, the validity of this management is unclear. The aims of the present study are to analyze treatment outcomes for recurrent SP according to the type of SP and RFI, and to check the validity of conservative treatment for patients according to type of SP and RFI. Methods We included 1,250 consecutive cases (624 right sided and 626 left side cases for the first episode) who were hospitalized and treated from January 2012 to June 2018. To investigate recurrence according to treatment modality (surgical or conservative treatment), we estimated RFI in each group during the observation period. RFI was measured from the completion of treatment to recurrence or last follow-up. We divided patients into two groups [the early (EG) and the late (LG) recurrence group] according to 1-year. Recurrence was defined as a subsequent episode of an ipsilateral SP, while a contralateral SP was regarded as an independent case in the present study. RFI between subgroups was compared using the Kaplan-Meier method with the log-rank test. A P value less than 0.05 (two-sided) was regarded as statistically significant. Results Recurrence occurred in 47 cases after surgical intervention for the first episode (585 cases). Recurrence occurred in 265 cases after conservative treatment for the first episode of SP (665 cases). For the first episode, the surgical group (SG) had a significantly longer RFI than the conservative group (CG), regardless of the type (both, P<0.001). Conservative treatment and surgical intervention for the second episode after conservative treatment for the first episode were performed in 98 and 167 cases, respectively. For the second episode after conservative treatment for the first episode, SG also had a significantly longer RFI than CG, regardless of the types (PSP P<0.001, SSP P=0.031). To check the validity of conservative treatment for patients with a long RFI, we analyzed recurrence by dividing patients into two groups according to one-year RFI. For PSP, the early recurrence group (EG, RFI ≤1 year) had 99 cases and the late recurrent group (LG, RFI >1 year) had 67 cases. SG had a significantly longer RFI than CG in both EG and LG (EG, P<0.001 and LG, P=0.001). In addition, for SSP, there were 67 cases of EG and 32 cases of LG, SG had significantly longer RFIs than CG in EG (P=0.007). However, there was no significant difference in RFI between SG and CG in LG (P=0.748). Conclusions The present study revealed diversity of management outcomes according to characteristics of recurrence and provides some evidences of the validity of conservative treatment in recurrent SSP with a long RFI. Further large-scale prospective randomized trials are required to validate these findings.
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Affiliation(s)
- In Sub Kim
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu-si, Gyeonggi-do, Republic of Korea
| | - Jae Jun Kim
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu-si, Gyeonggi-do, Republic of Korea
| | - Jung Wook Han
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu-si, Gyeonggi-do, Republic of Korea
| | - Seong Cheol Jeong
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu-si, Gyeonggi-do, Republic of Korea
| | - Yong Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu-si, Gyeonggi-do, Republic of Korea
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Liu YW, Chang PC, Chang SJ, Chiang HH, Li HP, Chou SH. Simultaneous bilateral thoracoscopic blebs excision reduces contralateral recurrence in patients undergoing operation for ipsilateral primary spontaneous pneumothorax. J Thorac Cardiovasc Surg 2020; 159:1120-1127.e3. [PMID: 31606164 DOI: 10.1016/j.jtcvs.2019.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/23/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Contralateral recurrence in patients with primary spontaneous pneumothorax is approximately 15%. If positive for blebs, the recurrence rate increases to 26%. This study seeks to determine whether simultaneous contralateral video-assisted thoracic surgery blebs excision would effectively lower the contralateral incidence of pneumothorax in patients undergoing surgery for ipsilateral primary spontaneous pneumothorax. METHODS Between January 2009 and December 2015, 335 patients with primary spontaneous pneumothorax, surgically treated in a single institution, were retrospectively studied. The median follow-up was 75 (50-99) months. All patients received video-assisted thoracic surgery blebectomy/bullectomy with pleural abrasions. They were classified into 3 groups: (1) ipsilateral video-assisted thoracic surgery without contralateral blebs/bullae included 142 patients with ipsilateral primary spontaneous pneumothorax without contralateral blebs/bullae only receiving ipsilateral video-assisted thoracic surgery; (2) ipsilateral video-assisted thoracic surgery with contralateral blebs/bullae included 123 patients with ipsilateral primary spontaneous pneumothorax with contralateral blebs/bullae receiving only ipsilateral video-assisted thoracic surgery; and (3) bilateral video-assisted thoracic surgery with contralateral blebs/bullae included 70 patients with ipsilateral primary spontaneous pneumothorax with contralateral blebs/bullae receiving 1-stage bilateral video-assisted thoracic surgery. Demographic data, perioperative details, recurrence patterns, recurrence-free survivals, and risk factors were compared. RESULTS The percentage of contralateral recurrence for the ipsilateral video-assisted thoracic surgery without contralateral blebs/bullae, ipsilateral video-assisted thoracic surgery with contralateral blebs/bullae, and bilateral video-assisted thoracic surgery with contralateral blebs/bullae groups differed significantly (0.7%, 14.6%, and 2.9%, respectively; P = .002). Multivariate analysis using the Cox proportional hazard model revealed that age less than 18 years (hazard ratio, 2.71; 95% confidence interval, 1.14-6.44; P = .024) and ipsilateral video-assisted thoracic surgery with contralateral blebs/bullae (hazard ratio, 22.13, 95% confidence interval, 2.96-165, P = .003) were predictors of contralateral recurrence, of which recurrence-free survival was notably different among groups as determined by Kaplan-Meier analysis (P < .0001). CONCLUSIONS Simultaneous contralateral blebectomy in patients with primary spontaneous pneumothorax receiving ipsilateral video-assisted thoracic surgery significantly lowered future contralateral recurrence.
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Affiliation(s)
- Yu-Wei Liu
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Chih Chang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shun-Jen Chang
- Department of Kinesiology, Health and Leisure Studies, National University of Kaohsiung, Kaohsiung, Taiwan
| | - Hung-Hsing Chiang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsien-Pin Li
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shah-Hwa Chou
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Surgery, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan.
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Ng GYH, Nah SA, Teoh OH, Ong LY. Primary spontaneous pneumothorax in children: factors predicting recurrence and contralateral occurrence. Pediatr Surg Int 2020; 36:383-389. [PMID: 31993738 DOI: 10.1007/s00383-020-04619-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The risk factors for recurrence in primary spontaneous pneumothorax (PSP) in children are not well known. We aimed to identify possible risk factors, and to evaluate the utility of computerised tomography (CT) scans in predicting future episodes. METHODS We reviewed children aged < 18 years admitted to our institution for PSP from 2008 to 2017, excluding those with malignancies. Basic demographic data were extracted. Clinical data collected include pneumothorax laterality, CT results, treatment protocols and recurrences. RESULTS 63 patients were included, 19 (30.2%) of whom had CT scans. A total of 41 surgeries were performed. The median (interquartile range) age was 15.4 years (14.9-15.9), and body-mass index was 17.9 kg/m2 (15.8-19.3). 56 (88.9%) patients were male. Median follow-up duration was 19.8 months (11.6-35.9). Multivariate logistic regression analyses identified surgery in the first episode as a predictor for a subsequent contralateral occurrence (odds ratio [95% confidence interval] 32.026 [1.685-608.518], p = 0.021). No predictors for ipsilateral recurrence were found. CT scans were 76.5% sensitive for bleb detection, and predicted poorly for occurrence (positive predictive value 14.3%, likelihood ratio 1.1). CONCLUSION This is the first study demonstrating that surgery at first presentation appears to predict for occurrence of PSP on the contralateral lung. CT appears to be ineffective in detecting blebs and predicting PSP occurrence.
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Affiliation(s)
- Glenn Yang Han Ng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,General Paediatrics Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Shireen Anne Nah
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore.,Paediatric Surgery Unit, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Oon Hoe Teoh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Respiratory Medicine Service, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Lin Yin Ong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. .,Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore.
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20
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The accuracy of computed tomography in detecting surgically resectable blebs or bullae in primary spontaneous pneumothorax. Radiol Med 2019; 124:833-837. [PMID: 31134432 DOI: 10.1007/s11547-019-01044-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Chest computed tomography is commonly used in patients with primary spontaneous pneumothorax to detect the presence of pulmonary blebs or bullae. The aim of this study is to calculate the accuracy of chest computed tomography to detect surgically resectable blebs or bullae in patients with primary spontaneous pneumothorax. METHODS This is a retrospective study includes all patients with primary spontaneous pneumothorax who underwent chest computed tomography evaluation for their disease over the period from January 2005 to December 2015. Patients who underwent surgical exploration were sub-grouped to calculate the sensitivity and the specificity of the chest computed tomography to detect surgically resectable pulmonary blebs or bullae. RESULTS A total of 143 patients were included in the study. Among them, 120 patients underwent surgical exploration with the finding of 95.7% sensitivity and 42.3% specificity for the chest computed tomography in detection of surgically resectable pulmonary blebs or bullae. CONCLUSION The sensitivity of the chest computed tomography scan is high in detecting surgically resectable pulmonary blebs or bullae. However, the specificity is low. This may lead to overdiagnosis of the patients to have pulmonary blebs and bullae. Therefore, the routine use of chest computed tomography scan before the surgical exploration in patients with primary spontaneous pneumothorax should depend on the clinical judgment.
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21
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Nishimoto K, Fujisawa T, Yoshimura K, Enomoto Y, Enomoto N, Nakamura Y, Inui N, Sumikawa H, Johkoh T, Colby TV, Suda T. The prognostic significance of pneumothorax in patients with idiopathic pulmonary fibrosis. Respirology 2017; 23:519-525. [DOI: 10.1111/resp.13219] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/10/2017] [Accepted: 10/15/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Koji Nishimoto
- Second Division, Department of Internal Medicine; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Tomoyuki Fujisawa
- Second Division, Department of Internal Medicine; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Katsuhiro Yoshimura
- Second Division, Department of Internal Medicine; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Yasunori Enomoto
- Second Division, Department of Internal Medicine; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Noriyuki Enomoto
- Second Division, Department of Internal Medicine; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Naoki Inui
- Second Division, Department of Internal Medicine; Hamamatsu University School of Medicine; Hamamatsu Japan
- Department of Clinical Pharmacology and Therapeutics; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Hiromitsu Sumikawa
- Department of Radiology; Osaka International Cancer Institute; Osaka Japan
| | - Takeshi Johkoh
- Department of Radiology; Kinki Central Hospital of Mutual Aid Association of Public School Teachers; Itami Japan
| | - Thomas V. Colby
- Department of Laboratory Medicine and Pathology; Mayo Clinic Arizona; Scottsdale AZ USA
| | - Takafumi Suda
- Second Division, Department of Internal Medicine; Hamamatsu University School of Medicine; Hamamatsu Japan
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