Abstract
BackgroundIn 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.MethodsOne 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.ResultsSignificant 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).ConclusionsAlthough 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.
Highlights
In adults with primary spontaneous pneumothorax (PSP), contralateral recurrence occurs in about 25–28% when there are asymptomatic blebs
Recurrence has always been a serious problem associated with PSP, yet it remains unclear what factors predispose its recurrence in adolescents and how it can best be managed surgically
Patients were classified into three groups–patients with contralateral blebs receiving one-stage bilateral surgeries (B+cb), patients with contralateral blebs only receiving unilateral surgery (U+cb), and patients without contralateral blebs only receiving unilateral surgery (U−cb) (Fig. 1)
Summary
In adults with primary spontaneous pneumothorax (PSP), contralateral recurrence occurs in about 25–28% when there are asymptomatic blebs. Recurrence has always been a serious problem associated with PSP, yet it remains unclear what factors predispose its recurrence in adolescents and how it can best be managed surgically. In CT scans performed by Soccorso et al, 20% (10/49) of their pediatric patients with PSP had asymptomatic contralateral blebs/bullae. Among those with the blebs, 40% developed pneumothorax within six months [9]. Some studies of adult PSP have associated asymptomatic contralateral blebs with a 25–28% risk of future spontaneous pneumothorax [3, 10,11,12]
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