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Pneumothorax Surgery Under One-lung Versus Two-lung Ventilation; Will Different Ventilation Method Matter On Recurrence?
Younggi Jung, Eunjue Yi, Sungho Lee, Jae Ho Chung;
Korea University Anam Hospital, Seoul, Korea, Republic of
BACKGROUND: Pneumothorax surgery is traditionally performed under one-lung ventilation rather than two-lung ventilation for many reasons. Concerns about two-lung ventilation exists regarding suboptimal surgical view and possibility of lung injury. However, it may shorten the induction time and decrease the volumetric stress on contralateral lung parenchyma. This may affect the recurrence of pneumothorax and also the incidence of contralateral pneumothorax. We compared the recurrence patterns of pneumothorax surgery performed under two different ventilation strategies, define likelihood of recurrence based on severity of lung dystrophy and evaluated the feasibility of two-lung ventilation in thoracoscopic pneumothorax surgery.
METHODS: Medical records were retrospectively reviewed for primary spontaneous pneumothorax patients who received thoracoscopic surgery under one or two-lung ventilation. Preoperative CT scans and Dystrophic severity score (DSS) were used to compare recurrence patterns in two distinct groups.
RESULTS: Among the 180 enrolled patients, 145 received surgery under one-lung ventilation and 35 under two-lung ventilation. Patient characteristics were similar for both groups. Induction time for anesthesia (20min vs. 25min, p=0.001) and operation time (30min vs. 45min, p=0.001) were shorter in two-lung group. Two-lung group received surgery at a lower tidal volume setting (380ml vs 450ml, p=0.001). In total, 19.44% (one-lung group 19.31% vs two-lung group 20%, p=0.41) of operated patients experienced pneumothorax recurrence at either ipsilateral or contralateral side. Recurrence at ipsilateral side was lower in one-lung group (8.28% vs. 14.29%) wherease contralateral recurrence was lower in two-lung group (11.03% vs 5.71%). One-lung and two-lung ventilation groups showed a 1-year recurrence free survival rate of 84.2% and 75.7% respectively (p=0.25). Increased DSS value correlated with decreased recurrence free survival in both ventilation groups, and in two-lung group the correlation increased more significantly with the increase in the DSS value (1-year RFS: 1.00 vs 0.86 vs 0.46, p=0.03).
CONCLUSIONS: Different ventilation techniques showed a difference in the postoperative pneumothorax recurrence patterns. Two-lung ventilation resulted in better RFS in patients with low DSS but showed abrupt increase in recurrence for those with high DSS thus careful evaluation of preoperative CT scan and decision of ventilation method may improve the recurrence of pneumothorax.
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