The Safety and Efficacy of Secondary Spontaneous Pneumothorax Surgery: Especially in Interstitial Lung Disease and Chronic Obstructive Pulmonary Disease.

OBJECTIVES

To clarify the surgical indications for secondary spontaneous pneumothorax (SSP), we compared the outcomes between interstitial lung disease (ILD)- and chronic obstructive pulmonary disease (COPD)-associated SSP using propensity score matching (PSM) and identified the risk factors for recurrence, prolonged air leakage (PAL), and postoperative complications.

METHODS

We retrospectively analysed 138 patients who underwent SSP surgery for the first time. Outcomes were 3-year overall survival (OS), recurrence-free survival (RFS), and short-term outcomes (PAL ≥2 days; postoperative complications [Clavien-Dindo grade ≥3] and mortality). After 1:1 PSM, we compared ILD with COPD and explored group-specific risk factors.

RESULTS

The median postoperative air leak duration was 0 days (range: 0-13). Complications occurred in 3.6%, and mortality in 2.2% of cases. Three-year OS and RFS were 85.3% and 77.7%, respectively. ILD was a risk factor for recurrence (hazard ratio [HR] 6.29, 95% confidence interval [CI] 2.29-17.33; P < .001). After PSM (25 pairs), ILD showed worse RFS (P = .001) and OS (P = .010), while short-term outcomes were comparable. In ILD, interstitial abnormalities involving >1 lobe were a risk factor for recurrence (HR 13.74, 95% CI 2.78-67.95; P = .001), and combined pulmonary fibrosis and emphysema (CPFE) was a risk factor for PAL (odds ratio [OR] 7.94, 95% CI 1.32-47.62; P = .023). In COPD, ipsilateral pneumothorax history was a risk factor for recurrence (HR 15.50, 95% CI 1.81-133.20; P = .012).

CONCLUSIONS

SSP appears safe for selected patients. Despite worse long-term outcomes in ILD, comparable short-term results support surgery when benefits are expected; caution is warranted in patients with interstitial abnormalities in >1 lobe, CPFE, or steroid therapy.