title: Primary spontaneous pneumothorax: a cohort study of VATS with talc poudrage.
abstract: Video-assisted thoracoscopic surgery (VATS) is an increasingly common treatment for recurrent or persistent primary spontaneous pneumothorax (PSP). Surgery usually involves diffuse treatment of the pleura and possible targeted therapy to areas of bullous disease. The purpose of this large cohort study was to examine incidence of recurrence after VATS and identify predictors of outcome.
  
  
  
  Patients undergoing VATS for PSP at a single centre between 2000 and 2012 were prospectively enrolled. All patients underwent talc poudrage. Targeted surgical techniques were used based on presence of air leak and Vanderschueren's stage. Patients had clinical and radiological follow-up for at least 2 years (median 8.5 years).
  
  
  
  1415 patients with PSP underwent VATS with talc poudrage. The most frequent indications were recurrent pneumothorax (92.2%) and persistent air leak (6.5%). The complication rate was 2.0% of which 1.7% was prolonged air leak. There was no mortality. Median length of stay was 5 days. Recurrent pneumothorax occurred in 26 patients (1.9%). At the time of surgery, 592 patients smoked (43%) and they had a significantly higher incidence of recurrence (24/575, 4.2%) than non-smokers (2/805, 0.2%), p<0.001. The incidence of recurrence in those undergoing bullae suturing (3.8%, n=260) was significant higher than those undergoing poudrage alone (0.3%, p=0.036).
  
  
  
  The marked difference in recurrence between smokers and non-smokers suggests this as an important predictor of outcome. This study demonstrates a low incidence of recurrence and complications for patients with PSP undergoing VATS with talc poudrage. Talc poudrage requires prospective comparison with pleurectomy and mechanical abrasion.
authors.affiliation: Unit of Thoracic Surgery, L. Spallanzani Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cardillo
authors.affiliation: Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
authors.forename: Oliver J
authors.identifier: 0000-0002-9416-5249
authors.initials: OJ
authors.lastname: Bintcliffe
authors.affiliation: Unit of Thoracic Surgery, L. Spallanzani Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Carleo
authors.affiliation: Unit of Thoracic Surgery, L. Spallanzani Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Carbone
authors.affiliation: Unit of Thoracic Surgery, L. Spallanzani Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Di Martino
authors.affiliation: Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK.
authors.forename: Brennan C
authors.initials: BC
authors.lastname: Kahan
authors.affiliation: Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
authors.forename: Nick A
authors.initials: NA
authors.lastname: Maskell
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D018700:Pleurodesis / Q000009:adverse effects / Q000379:methods*; D011030:Pneumothorax / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D013627:Talc / Q000008:administration & dosage*; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D013627:Talc
keywords: Pleural Disease; Thoracic Surgery