Impact of ventilation strategy on recurrence patterns after pneumothorax surgery: a stratified analysis by lung dystrophy

초록

Background: Pneumothorax surgery is typically performed under one-lung ventilation (OLV); however, two-lung ventilation (TLV) may reduce volumetric stress on the contralateral lung, potentially lowering subsequent contralateral pneumothorax and shorten overall operation time thus we compared recurrence patterns of pneumothorax under two different ventilation strategies and defined likelihood of recurrence based on lung dystrophy and evaluated the feasibility of TLV. Methods: This study retrospectively analyzed 180 primary spontaneous pneumothorax (PSP) patients who underwent thoracoscopic surgery utilizing two different ventilation methods. Preoperative CT scans were used to calculate the Dystrophic Severity Score (DSS), and a subgroup analysis was conducted to evaluate the association between the extent of lung dystrophy and the risk of pneumothorax recurrence. Results: One hundred and forty-five patients received pneumothorax surgery under OLV and 35 underwent surgery under TLV and all patients showed similar baseline characteristics. The TLV group showed shorter induction and operation time (20 vs. 25 min and 30 vs. 45 min, respectively). While ipsilateral recurrence was lower in the OLV group (8.3% vs. 14.3%), contralateral recurrence was lower in the TLV group (5.7% vs. 11.0%). One-year recurrence-free survival (RFS) was 84.2% and 75.7%, respectively. An increase in the DSS value was associated with a higher recurrence rate in both groups, with this trend being notably more pronounced in the TLV group. Conclusions: Higher preoperative DSS showed strong association with postoperative recurrence, especially on contralateral recurrence when TLV was utilized. Therefore, using the DSS for preoperative risk stratification to guide the selection of an optimal ventilation strategy may be important and could be considered for improving surgical outcomes in pneumothorax treatment.

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