title: Apex-to-Cupola Distance Following VATS Predicts Recurrence in Patients With Primary Spontaneous Pneumothorax.
abstract: Our study sought to determine whether the size of the residual apical pleural space in young patients with primary spontaneous pneumothorax (PSP) following video-assisted thoracoscopic surgery is associated with the risk of recurrence. We retrospectively reviewed patients (≤30 years' old) with primary spontaneous pneumothorax following thoracoscopic surgery (2002-2010) in a university-affiliated hospital. The size of residual apical pleural space was estimated by measuring the apex-to-cupola distance on a postoperative chest radiograph at 2 time windows: first between postoperative day (POD) 0 and 3, and second between POD 4 and 14. A total of 149 patients were enrolled with a median follow-up of 11.2 months (interquartile range, 0.95-29.5 months), of whom 141 (94.6%) were male with a mean age of 20 years. The postoperative recurrence rate was 11.4%. Comparing the characteristics between the patients with and without recurrent pneumothorax, the patients with recurrence were younger (18.2 + 2.4 vs 20.7 + 3.7 years, P = 0.008), with a lower rate of pleurodesis (35% vs1 69%, P = 0.037), longer apex-to-cupola distance at POD 0 to 3 (22.41 ± 19.56 vs 10.07 ± 10.83 mm, P < 0.001) and POD 4 to 14 (11.82 ± 9.75 vs 5.54 ± 8.38 mm, P = 0.005) than the patients without recurrence. In a multivariate logistic regression model for recurrent pneumothorax, age <18 years (P = 0.026, odds ratio [OR]: 4.694), apex-to-cupola distance at POD 0 to 3 >10 mm (P = 0.027, OR: 5.319), and no pleurodesis during VATS (P = 0.022, OR: 5.042) were independent risk factors for recurrent pneumothorax. The recurrence rate was not low (11.4%) in young patients with PSP following VATS. Residual apical pleural space with apex-to-cupola distance of 10 mm or greater at POD 0 to 3, younger age, and no pleurodesis would increase postoperative recurrence of primary spontaneous pneumothorax.
authors.affiliation: From the Department of Surgery, Division of Thoracic Surgery, Chia-Yi Christian Hospital, Chia-Yi; (JMC); Department of Surgery, Division of Thoracic Surgery, National Cheng Kung University Hospital, Tainan; (WWL, YTY, YLT, YYC); Department of Surgery, Division of Thoracic Surgery, Tainan Municipal Hospital, Tainan; (MHW); Division of Pulmonary and Critical Care Medicine, Chiayi Christian Hospital, and Department of Respiratory Therapy, China Medical University, Taiwan; (WC); and Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN (RWL).
authors.forename: Jia-Ming
authors.initials: JM
authors.lastname: Chang
authors.forename: Wu-Wei
authors.initials: WW
authors.lastname: Lai
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Yen
authors.forename: Yau-Lin
authors.initials: YL
authors.lastname: Tseng
authors.forename: Ying-Yuan
authors.initials: YY
authors.lastname: Chen
authors.forename: Ming-Ho
authors.initials: MH
authors.lastname: Wu
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.forename: Richard W
authors.initials: RW
authors.lastname: Light
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D008297:Male; D035422:Pleural Cavity / Q000473:pathology*; D011030:Pneumothorax / Q000473:pathology* / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D020775:Thoracic Surgery, Video-Assisted; D055815:Young Adult