Thoracoscopic pleurodesis for primary spontaneous pneumothorax with high recurrence risk: a prospective randomized trial.
OBJECTIVE
To compare the efficacy and safety between apical pleurectomy and pleural abrasion with minocycline in primary spontaneous pneumothorax (PSP) with high recurrence risk.


BACKGROUND
The optimal thoracoscopic pleurodesis procedure for PSP with high recurrence risk remains controversial.


METHODS
Between January 2006 and May 2009, a total of 369 patients with spontaneous pneumothorax were treated by video-assisted thoracoscopic surgery. After stapled bullectomy, 160 patients with no identifiable bleb or multiple blebs (≥3) were randomly chosen to undergo apical pleurectomy (pleurectomy group, 80 patients) or pleural abrasion with minocycline (abrasion/minocycline group, 80 patients).


RESULTS
Patients in the pleurectomy group had a longer operation duration (mean, 81.4 minutes vs 55.8 minutes, P < 0.001), a greater amount of operation bleeding (mean, 29.4 mL vs 13.2 mL, P = 0.025), and a greater amount of postoperative chest drainage (mean, 287.4 mL vs 195.8 mL, P = 0.040). Patients in the abrasion/minocycline group had a higher intensity of chest pain and required more frequent meperidine injections. Hemothorax occurred in 3 pleurectomy patients (3.8%). The short-term results showed that the 2 groups had comparable durations of postoperative chest drainage, durations of postoperative hospital stay, and complication rates. After a mean follow-up of 26.1 months, recurrent ipsilateral pneumothorax occurred in 3 patients (3.8%) in the pleurectomy group and 3 patients (3.8%) in the abrasion/minocycline group. Postoperative long-term residual chest pain and pulmonary function were comparable in both groups.


CONCLUSIONS
: Pleural abrasion with minocycline pleurodesis is as effective as apical pleurectomy and either technique is appropriate for treating PSP patients with high recurrence risk. This trial was registered at http://www.clinicaltrials.gov (ID: NCT00270751).
Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. chenjs@ntu.edu.tw
Jin-Shing
JS
Chen
Hsao-Hsun
HH
Hsu
Pei-Ming
PM
Huang
Shuenn-Wen
SW
Kuo
Mong-Wei
MW
Lin
Chin-Chih
CC
Chang
Jang-Ming
JM
Lee
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008911:Minocycline / Q000008:administration & dosage; D010994:Pleura / Q000601:surgery; D018700:Pleurodesis / Q000379:methods*; D011030:Pneumothorax / Q000601:surgery / Q000628:therapy*; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D016037:Single-Blind Method; D013906:Thoracoscopy; D055815:Young Adult
D008911:Minocycline