title: Surgical access rather than method of pleurodesis (pleurectomy or pleural abrasion) influences recurrence rates for pneumothorax surgery: systematic review and meta-analysis.
abstract: OBJECTIVE
  Surgery for recurrent spontaneous pneumothoraces is one of the most commonly performed procedures in thoracic surgery, but few studies have evaluated the efficacy of the surgical treatment options. We aimed to evaluate the influence of the type of pleurodesis on recurrence whilst adjusting for surgical access by systematic review and meta-regression of randomised and non-randomised trials.
  
  
  METHODS
  A systematic literature search undertaken for studies on pneumothorax surgery in MEDLINE, EMBASE, Cochrane Library, Internet trial registers and conference abstracts identified 29 studies (4 randomised and 25 non-randomised) eligible for inclusion. Meta-regression was performed adjusting for access to screen for evidence of a difference in recurrence rates.
  
  
  RESULTS
  Access remained the principal determinant of recurrence rates after surgery. The relative risk of recurrence was 4.731 (2.699-8.291; p < 0.001) using video-assisted thoracoscopic surgery compared to open access. After adjusting for access, the relative risk of recurrence of pleural abrasion compared to pleurectomy was observed to be 2.851 (95 % CI 0.478-17.021), but this was not statistically (p = 0.220).
  
  
  CONCLUSIONS
  Surgical access remains the most important factor that influences outcome after surgery for recurrent pneumothoraces. Although the relative risk of recurrence was higher with pleural abrasion compared to pleurectomy, it was not statistically significant, and more work needs to be conducted to address this question.
authors.affiliation: Thoracic Surgery Department, Guy's and St. Thomas' Hospital, London SE1 9RT, UK. andrea_bille@hotmail.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Bille
authors.forename: Allanah
authors.initials: A
authors.lastname: Barker
authors.forename: Eleni C
authors.initials: EC
authors.lastname: Maratos
authors.forename: Lyn
authors.initials: L
authors.lastname: Edmonds
authors.forename: Eric
authors.initials: E
authors.lastname: Lim
mesh_terms: D016009:Chi-Square Distribution; D006801:Humans; D018700:Pleurodesis / Q000009:adverse effects* / Q000379:methods; D011030:Pneumothorax / Q000601:surgery*; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*; D016896:Treatment Outcome