Chest
Volume 127, Issue 6, June 2005, Pages 2226-2230
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Minimally Invasive Techniques
Video-Assisted Thoracoscopic Surgery for Primary Spontaneous Pneumothorax: Evaluation of Indications and Long-term Outcome Compared With Conservative Treatment and Open Thoracotomy

https://doi.org/10.1378/chest.127.6.2226Get rights and content

Study objectives

Video-assisted thoracoscopic surgery (VATS) is effective for primary spontaneous pneumothorax. We sought to evaluate the outcome of VATS compared to conservative treatment and open thoracotomy, and to discuss the indications for VATS in primary spontaneous pneumothorax.

Design

Retrospective study.

Patients and interventions

Primary spontaneous pneumothorax was diagnosed in 281 consecutive patients between January 1989 and April 2001. Mean age was 29.1 years. Mean follow-up period was 78.3 months (range, 13 to 163 months). For these patients, conservative treatment, open thoracotomy, or VATS were performed, and the outcomes of the three treatments were evaluated. If recurrence occurred, outcome of treatment for the recurrence was also evaluated according to the number of times of recurrence.

Results

Recurrences were observed in 109 of 281 patients (38.8%). Forty-three patients (15.3%) had repeat recurrences. Regarding the outcome of the first episode, recurrence rates were 54.7% for conservative treatment, 7.7% for open thoracotomy, and 10.3% for VATS. Recurrence rates after the second episode were 60.3% for conservative treatment, 0% for open thoracotomy, and 18.6% for VATS. Overall recurrence rates of each treatment were 56.4%, 3.0%, and 11.7%, respectively. There was no statistical difference between the open thoracotomy and VATS groups (p = 0.15). Hospital stays from operation until discharge were 11.5 days for open thoracotomy and 4.1 days for VATS (p < 0.001).

Conclusion

The outcomes of VATS were very good compared to conservative treatment and equal to those of the open thoracotomy, not only for the first episode but also for the case of recurrence. In terms of low morbidity, low invasiveness, and cosmetic issues, VATS is superior to open thoracotomy. VATS is standard in cases of recurrence and should be considered for treatment at the first episode.

Section snippets

Patients Characteristics and Treatment Protocol

This retrospective study was carried out by reviewing medical records. Between January 1989 and April 2001, 281 consecutive patients were referred with a diagnosis of primary spontaneous pneumothorax. History of pneumothorax and treatment method were carefully reviewed. All of this information was added to our data and evaluated in this study.

Our treatment diagram is shown in Figure 1. Before November 1993 (previous to induction of VATS), conservative treatment, including observation,

Results

During this study period, 281 patients (255 male and 26 female) were referred to our hospital with primary spontaneous pneumothorax. The mean (± SD) age was 29.1 ± 13.6 (range, 5 to 79 years). The right lung was involved in 127 patients, and left lung was involved in 154 patients. Data were evaluated on July 2002. The mean follow-up period was 78.3 months (range, 13 to 163 months).

A summary of clinical courses and treatments of all 281 patients in shown in Table 1. Recurrences were observed in

Discussion

Spontaneous primary pneumothorax has traditionally been managed by conservative treatment including observation and tube thoracotomy. Only in cases of prolonged air leakage and recurrence was a surgical procedure considered. However, since the initiation of VATS, it seems that the treatment of primary spontaneous pneumothorax has been changed dramatically. Many investigators10111213 have reported its usefulness and safety. However, there are still some issues to be discussed: (1) might VATS

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