Outcomes of thoracoscopic management of secondary pneumothorax in patients with COPD and interstitial pulmonary fibrosis

We retrospectively analyzed the outcomes of surgical treatment for patients with secondary spontaneous pneumothorax.

Among consecutive patients with secondary pneumothorax who had undergone surgical treatment from 1993 to 2007, those with chronic obstructive pulmonary diseases (COPD) and those with diffuse pulmonary fibrotic diseases (PFD) were collected and divided into two groups (COPD group and PFD group). Postoperative morbidity and mortality were analyzed between the two groups.

We enrolled 72 patients (73 surgeries) as the COPD group and 14 patients (14 surgeries) as the PFD group. All of the surgical treatments were initiated through thoracoscopy. Mean age of the patients at surgery was significantly older in the COPD group compared with the PFD group. The surgeries in the COPD group were significantly longer than those in the PFD group. The bleeding volume during surgery in the COPD group was higher than that in the PFD group. Thoracoscopy was more frequently replaced with open thoracotomy in the PFD group (21.4%) than in the COPD group (2.7%; p = 0.0019). In the PFD group, two patients died from postoperative exacerbation of the pulmonary fibrosis and one died from the sepsis caused by the empyema. One patient in the COPD group died of pneumonia. The postoperative mortality rate was significantly higher in the PFD group (21.4%) than in the COPD group (1.4%; p = 0.001).

Favorable results were obtained in patients in the COPD group. However, the postoperative mortality rate in the PFD group was significantly higher than those in the COPD group. This increase in the mortality rate in the PFD group was mainly caused by postoperative exacerbation of pulmonary fibrotic diseases.