Abstract
BackgroundTo investigate the development of neogenetic bullae or blebs on 1-year postoperative chest computed tomography after video-assisted thoracic surgery (VATS) in young patients with primary spontaneous pneumothorax (PSP).MethodsIn this prospective study, 10- to 20-year-old patients with PSP were treated via VATS with additional procedures (bullectomy, cold coagulation, coverage, pleural abrasion, or chemical pleurodesis). All patients underwent the additional procedures and computed tomography of the chest 1 year postoperatively for the assessment of neogenetic bullae. Postoperative PSP recurrence was monitored, and recurrence-free survival was evaluated using Kaplan-Meier analysis.ResultsFifty-seven patients (66 cases) aged 17 ± 2 years underwent VATS for PSP and were followed up for 938 ± 496 days. Of the 36 cases at 1-year follow-up, 23 (63.9%) showed neogenetic bullae, which were adjacent to the staple lines in 16 cases (69.6%). The 1- and 2-year recurrence-free survival rates were 88.9 and 85.1%, respectively. Nine of the 66 cases (13.6%) showed recurrence after 869 ± 542 days. A history of contralateral PSP was significantly associated with recurrence.ConclusionsVATS, combined with additional procedures, provides acceptable long-term results in young patients with PSP. Additional procedures reduce the recurrence rate of PSP but do not prevent the occurrence of neogenetic bullae. A history of contralateral PSP is a potential risk factor for post-VATS recurrence in young patients.
Highlights
To investigate the development of neogenetic bullae or blebs on 1-year postoperative chest computed tomography after video-assisted thoracic surgery (VATS) in young patients with primary spontaneous pneumothorax (PSP)
Spontaneous pneumothorax (SP) occurs without any trauma or obvious precipitating factors and includes primary spontaneous pneumothorax (PSP), which occurs in healthy people, and secondary spontaneous pneumothorax (SSP), which occurs in people with preexisting lung diseases [1, 2]
It should be noted that the neogenetic bullae developed on the upper lobe of the bullectomy sites and were frequently (69.6%) adjacent to the staple lines. These results suggest that the staple lines directly influenced postoperative neogenetic bulla formation
Summary
To investigate the development of neogenetic bullae or blebs on 1-year postoperative chest computed tomography after video-assisted thoracic surgery (VATS) in young patients with primary spontaneous pneumothorax (PSP). Pneumothorax is a respiratory disorder involving abnormal air accumulation in the thoracic cavity and is classified as spontaneous, traumatic, or iatrogenic [1]. A significant accumulation of air in the thoracic cavity requires management by needle aspiration, chest drainage, or surgical intervention [2]. Common surgical indications for PSP include a second ipsilateral pneumothorax, first contralateral pneumothorax, simultaneous bilateral pneumothorax, and persistent air leakage [2]. A bullectomy using video-assisted thoracic surgery (VATS) is currently the preferred surgical treatment for SP owing to its minimally invasive nature [4]. VATS is associated with a higher postoperative recurrence rate than open surgery [5], in younger patients [6,7,8]
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