Risk Factors and Management of Recurrence After VATS for Primary Spontaneous Pneumothorax in Young Patients

Hyo Jun Jang, Sukki Cho, Yong Won Seong, Kwhanmien Kim, Sanghoon Jheon

Seoul National University Bundang Hospital, Seongnam-si, Korea (South)

Date, time and location: 2018.05.26 13:30, Congress Hall, 2F–C

Abstract

Purpose

VATS wedge resection is generally accepted as a standard surgical procedure for primary spontaneous pneumothorax. In order to reduce the recurrence rate after VATS, additional procedures with various materials are applied. The aim was to evaluate predictive factors of recurrence after VATS and to compare outcome of treatments after recurrence.

Methods

From 2003 to 2015, a total of 838 patients of < 30 years old undergoing VATS were enrolled. All patients except 16 patients received follow-up recently by at clinics or telephone. The median duration of follow-up was 86.4 (25.0-171.4) months. The treatments for recurrence after VATS were observation, closed thoracostomy, chemical pleurodesis and reoperation. Freedom from recurrence was analyzed by the Kaplan-Meier method, and comparisons were made by the log-rank test. Risk factors of freedom from recurrence were analyzed by the Cox proportional hazard model.

Results

One-, 3-, 5-year recurrence rate was 9%, 16%, and 18% after VATS, respectively. The male (18% vs. 25%), > 20 years old (11% vs. 21%), and coverage at the stapled line with polyglycolic acid sheet (9% vs. 20%) were associated with significantly lower 5-year recurrence rate in univariate analysis and better prognostic factors for freedom from recurrence in multivariate analysis. Reoperation for recurrence after VATS showed significantly lower 5-year repeated recurrence rate compared to observation, closed thoracostomy and chemical pleurodesis (15.4% vs 34.3%, 56.1% and 28.6% p=0.002).

Conclusions

Recurrence rate after VATS is higher than expected due to intense and long-term follow-up. The visceral pleural coverage with polyglycolic acid sheet could reduce the recurrence rate. Reoperation for recurrence after VATS might be considered to reduce repeated recurrence.