Chest tube drainage versus video-assisted thoracoscopic surgery for a first episode of primary spontaneous pneumothorax: a systematic review and meta-analysis

Jean H. T. Daemen, Pieter W. J. Lozekoot, Jos G. Maessen, Michiel H. M. Gronenschild, Gerben P. Bootsma, Karel W. E. Hulsewe, Yvonne J. L. Vissers, Erik R. de Loos*

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review


Primary spontaneous pneumothorax affects up to 28 patients per 100 000 population yearly and is commonly resolved by chest tube drainage. However, drainage is also known to be associated with ipsilateral recurrence rates ranging from 25% to 43%. Preventive video-assisted thoracoscopic surgery (VATS) may be an effective alternative to diminish these recurrence rates and its associated morbidity. The aim of this study was to compare the efficacy of chest tube drainage and VATS as first line treatments of an initial episode of primary spontaneous pneumothorax. The MEDLINE, EMBASE, CENTRAL and databases were searched through 16 September 2018. Data regarding the ipsilateral recurrence rate and the length of hospitalization were extracted and submitted to meta-analysis using the random-effects model and the I-2 test for heterogeneity. Two randomized controlled trials and 2 observational studies were included, enrolling a total of 479 patients. Pairwise analysis demonstrated significantly reduced ipsilateral recurrence rates [odds ratio 0.15, 95% confidence interval (CI) 0.07-0.33; P <0.00001] and length of hospitalization (standardized mean difference -2.19, 95% CI -4.34 to -0.04; P = 0.046) in favour of VATS. However, a significant level of heterogeneity was detected for the length of hospitalization (I-2 = 97%; P <0.00001). Subgroup analysis that stratified study design found no statistical differences regarding recurrence rate. In conclusion, VATS can be an effective and attractive alternative to standard chest tube drainage, with reduced ipsilateral recurrence rates and length of hospitalization. However, given the low quality of the majority of included studies, more well-designed randomized controlled trials are necessary to strengthen the current evidence.

Original languageEnglish
Pages (from-to)819-829
Number of pages11
JournalEuropean Journal of Cardio-Thoracic Surgery
Issue number5
Publication statusPublished - Nov 2019


  • First episode
  • Primary spontaneous pneumothorax
  • Recurrence
  • Video-assisted thoracoscopic surgery
  • Chest tube drainage
  • 1ST-TIME
  • RISK

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