Long-term recurrence after surgery for recurrent primary spontaneous pneumothorax: pleural intervention versus...

The relative contributions of pleural intervention and surgical access to long-term recurrence after surgery for recurrent primary spontaneous pneumothorax remain uncertain. In this single-center retrospective cohort study, 315 patients younger than 35 years who underwent surgery for recurrent primary spontaneous pneumothorax after a second ipsilateral episode were included. Surgical treatment consisted of wedge resection combined with pleural abrasion or pleurectomy, performed through uniportal video-assisted thoracoscopic surgery or muscle-sparing mini-thoracotomy. The primary endpoint was recurrence-free survival. Kaplan-Meier analysis and Cox proportional hazards models were used to identify factors associated with postoperative recurrence. Overall recurrence occurred in 31 of 315 patients (9.8%) during a median follow-up of 64 months (IQR, 62-66); all included patients had at least 5 years of available follow-up. Recurrence was more frequent after pleural abrasion than after pleurectomy (14.4% vs. 4.7%, p = 0.004). In multivariable analysis, pleurectomy was independently associated with a lower hazard of recurrence than pleural abrasion (hazard ratio 0.255, 95% confidence interval 0.108-0.598; p = 0.002), whereas surgical access was not independently associated with recurrence-free survival (hazard ratio 1.023, 95% confidence interval 0.487-2.146; p = 0.953). Larger bullae, multiple bullae, and lower body mass index also remained independently associated with recurrence. Minimally invasive access was associated with more favorable perioperative recovery. In recurrent primary spontaneous pneumothorax, long-term recurrence appears to be more strongly associated with the pleural intervention strategy and baseline disease burden than with the route of surgical access. Pleurectomy was associated with lower recurrence, whereas minimally invasive access was associated with more favorable perioperative recovery.