Survival analysis of primary spontaneous pneumothorax in children treated with thoracoscopy: a single-center experience.

Objective: The objective of this study was to summarize the clinical characteristics and surgical outcomes of pediatric patients with primary spontaneous pneumothorax (PSP) treated by thoracoscopic surgery at a single center. Additionally, we aimed to identify risk factors for postoperative recurrence.

Methods: We retrospectively collected data from patients who underwent thoracoscopic surgery for PSP at the Department of Thoracic Surgery at Beijing Children's Hospital from March 2018 to March 2024. All patients underwent thoracoscopic wedge resection and pleurodesis. Based on Vanderschueren classification, we recorded intraoperative findings in the lung apices. Kaplan-Meier curves were used to assess postoperative recurrence trends over time. The log-rank test was used for univariate analysis, and the statistically significant factors in the univariate analysis were selected for further analysis in the multifactorial Cox regression model to explore the risk factors affecting postoperative recurrence in patients with PSP.

Results: A total of 90 cases of PSP were recorded during the study period and 63 cases of PSP were included in the study. The median age was 15.0 years, and male to female ratio was about 3:1. A total of 30 (30/63) patients had history of contralateral pneumothorax, 15 (15/63) had history of minimally invasive repair of pectus excavatum, and 6 (6/63) had Marfan's syndrome. All patients were treated with thoracoscopic pulmonary wedge resection and pleurodesis and were followed regularly after surgery. The K-Meier curve showed a declining trend in the first 2 years after surgery. Univariate analysis showed that gender, age, history of minimally invasive repair of pectus excavatum, history of contralateral pneumothorax, Marfan syndrome and Vanderschueren classification were significant risk factors for postoperative recurrence. Cox analysis demonstrated that male sex (HR = 5.25, p = 0.02, 95% CI (1.37-20.09)) and history of minimally invasive repair of pectus excavatum (HR = 3.767, p = 0.04, 95% CI (1.04-13.69)) were risk factors for recurrence.

Conclusion: Thoracoscopic treatment for PSP in children has a high rate of recurrence after surgery, particularly within the first 2 years after VATS. Female patients and patients with a history of MIPRE are possible high-risk groups for PSP after VATS. Recurrence needs to be monitored for 2 years after surgery, and reoperation may be required in cases of recurrence.