Takashi Iwazawa1,2, Yoshihisa Kadota3,4, Yukiyasu Takeuchi3,5, Hideoki Yokouchi3,6, Hiroyuki Shiono3,7, Masanobu Hayakawa3,8, Yasushi Sakamaki3,9, Eiji Kurokawa3,10, Kiyonori Nishioka3,11, Yasushi Shintani3,12. 1. Thoracic Surgery Study Group of Osaka University (TSSGO), Suita, Osaka, Japan. iwazawa@chp.toyonaka.osaka.jp. 2. Department of Surgery, Toyonaka Municipal Hospital, 4-14-1, Shibaharacho, Toyonaka, Osaka, 560-8565, Japan. iwazawa@chp.toyonaka.osaka.jp. 3. Thoracic Surgery Study Group of Osaka University (TSSGO), Suita, Osaka, Japan. 4. Department of Thoracic Surgery, Osaka Habikino Medical Center, Habikino, Osaka, Japan. 5. Department of Thoracic Surgery, Osaka Toneyama Medical Center, Toyonaka, Osaka, Japan. 6. Department of Thoracic Surgery, Suita Municipal Hospital, Suita, Osaka, Japan. 7. Department of General Thoracic Surgery, Nara Hospital, Kinki University School of Medicine, Ikoma, Nara, Japan. 8. Department of Thoracic Surgery, Higashiosaka City Medical Center, Higashi-ōsaka, Osaka, Japan. 9. Department of Thoracic Surgery, Osaka Police Hospital, Osaka, Japan. 10. Department of Thoracic Surgery, Minoh Municipal Hospital, Minoh, Osaka, Japan. 11. Department of Thoracic Surgery, Kinki Central Hospital of the Mutual Aid Association of Public School Teachers, Itami, Hyogo, Japan. 12. Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Abstract
OBJECTIVE: Various surgical procedures have been performed to decrease the recurrence of primary spontaneous pneumothorax after video-assisted thoracic surgery. This study aimed to examine the efficiency of pleural coverage for the prevention of postoperative recurrence in relatively young patients. METHODS: Between January 2008 and December 2012, a total of 357 cases of 345 patients (age 15-29 years) with primary spontaneous pneumothorax who underwent bullectomy at 13 institutions were enrolled in this multi-institutional retrospective cohort study. A concurrent bilateral operation was counted as two cases. Polyglycolic acid sheets were used in 238 cases, and oxidized regenerated cellulose sheets were used in 37 cases to cover the visceral pleura, with no pleural coverage in 82 cases. The average observation period was 4.2 ± 2.0 years. RESULTS: Postoperative recurrence was observed in 50 cases (14.0%) after video-assisted thoracic surgery. Twenty-six cases (10.9%) in the polyglycolic acid group, eight (21.6%) in the oxidized regenerated cellulose group, and sixteen (19.5%) in the non-coverage group experienced postoperative recurrence. Kaplan-Meier analysis revealed that the rate of freedom from postoperative recurrence in the polyglycolic acid group was significantly higher than that in the non-coverage group. Multivariate analysis showed that age ≥ 20 years and coverage with polyglycolic acid sheets were associated with reduced risk factors for postoperative recurrence. CONCLUSION: Pleural coverage with a polyglycolic acid sheet is suggested to be effective in preventing postoperative recurrence of pneumothorax compared with non-coverage in relatively young patients.
OBJECTIVE: Various surgical procedures have been performed to decrease the recurrence of primary spontaneous pneumothorax after video-assisted thoracic surgery. This study aimed to examine the efficiency of pleural coverage for the prevention of postoperative recurrence in relatively young patients. METHODS: Between January 2008 and December 2012, a total of 357 cases of 345 patients (age 15-29 years) with primary spontaneous pneumothorax who underwent bullectomy at 13 institutions were enrolled in this multi-institutional retrospective cohort study. A concurrent bilateral operation was counted as two cases. Polyglycolic acid sheets were used in 238 cases, and oxidized regenerated cellulose sheets were used in 37 cases to cover the visceral pleura, with no pleural coverage in 82 cases. The average observation period was 4.2 ± 2.0 years. RESULTS: Postoperative recurrence was observed in 50 cases (14.0%) after video-assisted thoracic surgery. Twenty-six cases (10.9%) in the polyglycolic acid group, eight (21.6%) in the oxidized regenerated cellulose group, and sixteen (19.5%) in the non-coverage group experienced postoperative recurrence. Kaplan-Meier analysis revealed that the rate of freedom from postoperative recurrence in the polyglycolic acid group was significantly higher than that in the non-coverage group. Multivariate analysis showed that age ≥ 20 years and coverage with polyglycolic acid sheets were associated with reduced risk factors for postoperative recurrence. CONCLUSION: Pleural coverage with a polyglycolic acid sheet is suggested to be effective in preventing postoperative recurrence of pneumothorax compared with non-coverage in relatively young patients.