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Video-Assisted Thoracoscopic Surgery for Primary Spontaneous Pneumothorax^*

Evaluation of Indications and Long-term Outcome Compared With Conservative Treatment and Open Thoracotomy

^* From the Departments of Surgery (Drs. Sawada and Moriyama) and Respiratory Medicine (Dr. Watanabe), Okayama Red Cross General Hospital, Okayama, Japan.

Correspondence to: Shigeki Sawada, MD, PhD, Department of Surgery Shikoku Cancer Center, 13 Horinouchi, Matsuyama, Ehime, 790-0007, Japan

Study objectives: Video-assisted thoracoscopic surgery (VATS) is effective for primary spontaneous pneumothorax. We sought to evaluate the outcome of VATS compared to conservative treatment and open thoracotomy, and to discuss the indications for VATS in primary spontaneous pneumothorax.

Design: Retrospective study.

Patients and interventions: Primary spontaneous pneumothorax was diagnosed in 281 consecutive patients between January 1989 and April 2001. Mean age was 29.1 years. Mean follow-up period was 78.3 months (range, 13 to 163 months). For these patients, conservative treatment, open thoracotomy, or VATS were performed, and the outcomes of the three treatments were evaluated. If recurrence occurred, outcome of treatment for the recurrence was also evaluated according to the number of times of recurrence.

Results: Recurrences were observed in 109 of 281 patients (38.8%). Forty-three patients (15.3%) had repeat recurrences. Regarding the outcome of the first episode, recurrence rates were 54.7% for conservative treatment, 7.7% for open thoracotomy, and 10.3% for VATS. Recurrence rates after the second episode were 60.3% for conservative treatment, 0% for open thoracotomy, and 18.6% for VATS. Overall recurrence rates of each treatment were 56.4%, 3.0%, and 11.7%, respectively. There was no statistical difference between the open thoracotomy and VATS groups (p = 0.15). Hospital stays from operation until discharge were 11.5 days for open thoracotomy and 4.1 days for VATS (p < 0.001).

Conclusion: The outcomes of VATS were very good compared to conservative treatment and equal to those of the open thoracotomy, not only for the first episode but also for the case of recurrence. In terms of low morbidity, low invasiveness, and cosmetic issues, VATS is superior to open thoracotomy. VATS is standard in cases of recurrence and should be considered for treatment at the first episode.

Key Words: conservative treatment • open thoracotomy • primary spontaneous pneumothorax • recurrence • video-assisted thoracoscopic surgery

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