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Original article
Primary spontaneous pneumothorax: a cohort study of VATS with talc poudrage
  1. Giuseppe Cardillo1,
  2. Oliver J Bintcliffe2,
  3. Francesco Carleo1,
  4. Luigi Carbone1,
  5. Marco Di Martino1,
  6. Brennan C Kahan3,
  7. Nick A Maskell2
  1. 1Unit of Thoracic Surgery, L. Spallanzani Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
  2. 2Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
  3. 3Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
  1. Correspondence to Prof Nicholas A Maskell, Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol BS10 5NB, UK; Nick.Maskell{at}bristol.ac.uk

Abstract

Background Video-assisted thoracoscopic surgery (VATS) is an increasingly common treatment for recurrent or persistent primary spontaneous pneumothorax (PSP). Surgery usually involves diffuse treatment of the pleura and possible targeted therapy to areas of bullous disease. The purpose of this large cohort study was to examine incidence of recurrence after VATS and identify predictors of outcome.

Methods Patients undergoing VATS for PSP at a single centre between 2000 and 2012 were prospectively enrolled. All patients underwent talc poudrage. Targeted surgical techniques were used based on presence of air leak and Vanderschueren's stage. Patients had clinical and radiological follow-up for at least 2 years (median 8.5 years).

Results 1415 patients with PSP underwent VATS with talc poudrage. The most frequent indications were recurrent pneumothorax (92.2%) and persistent air leak (6.5%). The complication rate was 2.0% of which 1.7% was prolonged air leak. There was no mortality. Median length of stay was 5 days. Recurrent pneumothorax occurred in 26 patients (1.9%). At the time of surgery, 592 patients smoked (43%) and they had a significantly higher incidence of recurrence (24/575, 4.2%) than non-smokers (2/805, 0.2%), p<0.001. The incidence of recurrence in those undergoing bullae suturing (3.8%, n=260) was significant higher than those undergoing poudrage alone (0.3%, p=0.036).

Conclusion The marked difference in recurrence between smokers and non-smokers suggests this as an important predictor of outcome. This study demonstrates a low incidence of recurrence and complications for patients with PSP undergoing VATS with talc poudrage. Talc poudrage requires prospective comparison with pleurectomy and mechanical abrasion.

  • Thoracic Surgery
  • Pleural Disease

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