title: Results of surgical treatment for secondary spontaneous pneumothorax according to underlying diseases.
abstract: OBJECTIVE
  The outcome of surgical treatment for secondary spontaneous pneumothorax (SSP) has rarely been investigated.
  
  
  METHODS
  We retrospectively reviewed 183 patients who underwent surgery for SSP. We categorized the patients into three groups according to underlying diseases: Group A (chronic obstructive pulmonary disease), Group B (interstitial pneumonia [IP]) and Group C (others). We defined treatment success as surgery without hospital mortality, postoperative complications, death within 6 months or ipsilateral recurrence of pneumothorax within 2 years. We assessed the risk factors for unsuccessful treatment using a Cox regression hazard model.
  
  
  RESULTS
  There were 123 patients in Group A, 20 in Group B and 40 in Group C. The hospital mortality rates were 2, 15 and 0% in Groups A, B and C, respectively. The hospital mortality, morbidity and pneumothorax recurrence rates in the IP group were higher than in the other groups. The 5-year overall survival rates were 78, 32 and 84% in Groups A, B and C, respectively; the prognosis of the IP group was significantly poorer. The treatment success rates were 86, 45 and 83% in Groups A, B and C, respectively. SSPs caused by IP and SSPs requiring open surgery were identified as the risk factors for unsuccessful treatment.
  
  
  CONCLUSIONS
  Surgery for SSP caused by underlying diseases other than IP yielded favourable results. However, a careful examination of surgical indication and a realistic disclosure for informed consent are required for patients with SSP caused by IP, because of the high treatment failure rate.
authors.affiliation: Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan i_junji@ba2.so-net.ne.jp.
authors.forename: Junji
authors.initials: J
authors.lastname: Ichinose
authors.affiliation: Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Nagayama
authors.affiliation: Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Haruaki
authors.initials: H
authors.lastname: Hino
authors.affiliation: Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Nitadori
authors.affiliation: Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Anraku
authors.affiliation: Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Murakawa
authors.affiliation: Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Nakajima
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000453:epidemiology / Q000209:etiology / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D013906:Thoracoscopy; D016896:Treatment Outcome
keywords: Chronic obstructive pulmonary disease; Interstitial pneumonia; Pneumothorax; Surgery; Thoracoscopy