Video-Assisted Thoracoscopic Surgery with Bullectomy and Partial Pleurectomy versus Chest Tube Drainage for Treatment of Secondary Spontaneous Pneumothorax—A Retrospective Single-Center Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Surgical Technique: VATS-Bullectomy with Partial Pleurectomy (VBPP)
2.2. Outpatient Care and Follow-Up
2.3. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | VBPP (n = 36) | CT (n = 46) | p-Value |
---|---|---|---|
Gender | |||
Male | 19 (52.8%) | 27 (58.7%) | |
Female | 17 (47.2%) | 19 (41.3%) | 0.592 |
Smoking status | |||
Smokers (current and past) | 30 (83.3%) | 31 (67.4%) | |
Non-smokers | 6 (16.7%) | 15 (32.6%) | 0.101 |
Pneumothorax size (cm) | |||
Collins < 4 cm | 5 (13.9%) | 4 (8.7%) | |
Collins ≥ 4 cm | 30 (83.3%) | 41 (89.1%) | |
Missing | 1 (2.8%) | 1 (2.2%) | 0.449 |
Age (yrs.) | |||
Median (Range) | 65 (41–87) | 60.5 (41–92) | 0.144 |
Height (m) | |||
Mean (SD) | 1.73 (0.08) | 1.72 (0.08) | 0.498 |
Weight (kg) | |||
Mean (SD) | 65.8 (10.51) | 64.7 (11.39) | 0.655 |
BMI (kg/m2) | |||
Median (Mean) | 21.5 (22) | 20.8 (21.8) | 0.483 |
ECOG status | |||
Grade 0–1 | 27 (75%) | 23 (50%) | |
Grade 2–3 | 8 (22.2%) | 12 (26.1%) | |
Grade 4 | 1 (2.8%) | 11 (23.9%) | 0.238 |
Charlson Comorbidity Index (score) | |||
1–2 | 20 (55.6%) | 24 (52.2%) | |
3–4 | 14 (38.9%) | 12 (23.1%) | |
5 | 2 (5.5%) | 10 (24.7%) | 0.302 |
Length of hospital stay (LOS) (days) | |||
Mean (SD) | 14.1 (8.99) | 9.3 (4.82) | 0.006 * |
Days until operation | |||
Mean (SD) | 7.1 (2.65) | / | / |
Complications | |||
Hemothorax | 5 (13.9%) | 1 (2.8%) | 0.043 * |
Acute pneumonia | 11 (30.6%) | 5 (10.9%) | 0.026 * |
Clavien-Dindo grade | |||
Grade I | 0 (0%) | 0 (0%) | |
Grade II | 14 (87.5%) | 6 (100%) | |
Grade IIIa | 2 (12.5%) | 0 (0%) | 0.375 |
In-hospital mortality | 0 (0%) | 0 (0%) | 1.00 |
COPD stage | |||
No COPD | 7 (19.4%) | 11(23.9%) | |
COPD Gold I | 5 (13.9%) | 2 (4.3%) | |
COPD Gold II | 6 (16.7%) | 3 (6.5%) | |
COPD Gold III | 13 (36.1%) | 21 (45.7%) | |
COPD Gold IV | 5 (13.9%) | 9 (19.6%) | 0.282 |
Cause of SSP | Total (N) | ||
COPD | 29 (80.6%) | 35 (76.1%) | 64 |
Tuberculosis | 6 (16.7%) | 5 (10.9%) | 11 |
Lung cancer | 1 (2.7%) | 6 (13%) | 7 |
Variable | Recurrence n (%) | p-Value |
---|---|---|
Gender | ||
Male | 19 (41.3) | |
Female | 6 (16.7) | 0.016 * |
Age | ||
≤median (63 years) | 14 (31.8) | |
>median (63 years) | 11 (28.9) | 0.778 |
BMI | ||
≤median (21.1 kg/m2) | 13 (31.0) | |
>median (21.1 kg/m2) | 12 (30.0) | 0.925 |
Smoking status | ||
Smokers (past and current) | 8 (38.1) | |
Non-smokers | 17 (27.3) | 0.380 |
Treatment | ||
VBPP | 6 (16.7) | |
CT | 19 (41.3) | 0.016 * |
Pneumothorax size | ||
Collins < 4 cm | 3 (33.3) | |
Collins ≥ 4 cm | 20 (28.2) | 0.747 |
Side of recurrence at presentation | ||
Ipsilateral | 12 (60) | |
Contralateral | 8 (40) | 0.211 |
COPD stage | ||
No COPD | 4 (22.2) | |
COPD Gold I-IV | 21 (32.8) | 0.389 |
Other causes of SSP | ||
Tuberculosis | 4 (22.2) | |
Lung cancer | 0 (77.8) | 0.024 * |
Risk Factor | Hazard Ratio | 95% CI | p-Value |
---|---|---|---|
Gender | |||
Female vs. Male | 2.803 | 1.118–7.030 | 0.021 * |
Age | |||
≤63 years vs. >63 years | 0.811 | 0.368–1.790 | 0.602 |
BMI | |||
≤21.1 kg/m2 vs. >21.1 kg/m2 | 1.073 | 0.489–2.355 | 0.861 |
Smoking status | |||
Non-Smokers vs. Smokers | 0.690 | 0.297–1.601 | 0.382 |
Treatment | |||
CT vs. VBPP | 0.196 | 0.077–0.498 | <0.001 * |
Pneumothorax size (cm) | |||
Collins < 4 vs. Collins ≥4 | 1.075 | 0.318–3.630 | 0.907 |
COPD stage | |||
COPD vs. no COPD | 1.051 | 0.358–3.082 | 0.927 |
Risk Factor | B | SE | Wald | Hazard Ratio | 95% CI | p-Value |
---|---|---|---|---|---|---|
Gender | ||||||
Female vs. Male | 0.931 | 0.494 | 3.544 | 2.536 | 0.962–6.684 | 0.060 |
Age | ||||||
≤63 years vs. >63 years | 0.005 | 0.018 | 0.065 | 1.005 | 0.969–1.041 | 0.799 |
BMI | ||||||
≤21.1 kg/m2 vs. >21.1 kg/m2 | 0.237 | 0.487 | 0.237 | 1.268 | 0.488–3.294 | 0.627 |
Smoking status | ||||||
Non-smokers vs. Smokers | −0.090 | 0.500 | 0.032 | 0.914 | 0.343–2.437 | 0.857 |
Treatment | ||||||
CT vs. VBPP | −1.893 | 0.548 | 11.938 | 0.151 | 0.051–0.441 | 0.001 * |
Pneumothorax size (cm) | ||||||
Collins < 4 vs. Collins ≥ 4 | −0.433 | 0.738 | 0.345 | 0.648 | 0.153–2.755 | 0.557 |
COPD | ||||||
no COPD vs. COPD | 0.610 | 0.685 | 0.793 | 1.840 | 0.481–7.041 | 0.373 |
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Fung, S.; Kivilis, M.; Krieg, A.; Schauer, A.; Rehders, A.; Dizdar, L.; Knoefel, W.-T. Video-Assisted Thoracoscopic Surgery with Bullectomy and Partial Pleurectomy versus Chest Tube Drainage for Treatment of Secondary Spontaneous Pneumothorax—A Retrospective Single-Center Analysis. Medicina 2022, 58, 354. https://doi.org/10.3390/medicina58030354
Fung S, Kivilis M, Krieg A, Schauer A, Rehders A, Dizdar L, Knoefel W-T. Video-Assisted Thoracoscopic Surgery with Bullectomy and Partial Pleurectomy versus Chest Tube Drainage for Treatment of Secondary Spontaneous Pneumothorax—A Retrospective Single-Center Analysis. Medicina. 2022; 58(3):354. https://doi.org/10.3390/medicina58030354
Chicago/Turabian StyleFung, Stephen, Marius Kivilis, Andreas Krieg, Anja Schauer, Alexander Rehders, Levent Dizdar, and Wolfram-Trudo Knoefel. 2022. "Video-Assisted Thoracoscopic Surgery with Bullectomy and Partial Pleurectomy versus Chest Tube Drainage for Treatment of Secondary Spontaneous Pneumothorax—A Retrospective Single-Center Analysis" Medicina 58, no. 3: 354. https://doi.org/10.3390/medicina58030354