Cause and management of recurrent primary spontaneous pneumothorax after thoracoscopic stapler blebectomy.

BACKGROUND: As the number of patients treated by thoracoscopic stapler blebectomy increased, the postoperative recurrence rate had risen unexpectedly. We retrospectively investigated the cause and management of primary spontaneous pneumothorax recurrence after thoracoscopic stapler blebectomy. METHODS: From March 1992 to the end of December 2006, thoracoscopic stapler blebectomy was performed in 357 patients with primary spontaneous pneumothorax at the Nihon University Itabashi Hospital. The causes and management of recurrence were investigated in 30 patients with postoperative recurrence based on items such as the resurgical observations, preoperative chest computed tomography findings, previous operative notes. RESULTS: Among the patients with bilateral pneumothorax, young patients exhibited a higher tendency for postoperative recurrence. The most common cause was new bulla formation (28 slides, 16 of which were apparently related to the staple line and 12 of which were not related to the staple line). CONCLUSION: In thoracoscopic stapler blebectomy for primary spontaneous pneumothorax, the most common cause of recurrence was new bulla formation. It is necessary to establish additional procedures involving either the visceral pleura or the parietal pleura to reduce the recurrence rate.

[Treatment with S-1 and radiation therapy for advanced lung cancer invading chest wall].

The patient was a 63-year-old man, who had been suffering from lung cancer with left chest wall invasion and contralateral pulmonary metastases. Due to the severe pain caused by this advanced lung cancer with poor performance status (PS), oxycodone was administered for treatment. Radiotherapy was used for local tumor control and oral S-1 was given as systemic chemotherapy. The local control rate (near CR) and the PS were improved effectively by this combination of palliative treatment. As a result, he was allowed to return home and followed as an outpatient. Our experience suggests that positive palliative treatment improves the quality of life (QOL) of patients and provides survival benefits.