Long-term ipsilateral recurrence and contralateral risk following surgery for primary spontaneous pneumothorax in young patients: age-related differences

Background: Primary spontaneous pneumothorax (PSP) is common in young individuals, but age-specific recurrence risks and optimal follow-up durations remain unclear. Therefore, we aimed to evaluate the long-term outcomes of PSP surgery, including recurrence and imaging findings, in patients aged ≤19 years and those aged 20-29 years. Methods: We retrospectively analyzed data concerning 357 patients (aged 10-29 years) who underwent thoracoscopic bullectomy with pleural covering between 2012 and 2021. Patients were grouped into two categories: patients aged ≤19 years (subdivided into those aged ≤15 and 16-19 years) and those aged 20-29 years. Clinical data, recurrence rates, and postoperative computed tomography (CT) findings were compared between the groups. Recurrence-free survival was analyzed using the Kaplan-Meier method and a log-rank test. Results: 4.6%, P<0.001) than those aged 20-29 years, with the highest crude recurrence observed in the ≤15-year subgroup. However, recurrence-free survival did not differ significantly among age groups on Kaplan-Meier analysis. Most recurrences occurred within 2 years, but contralateral events were observed beyond 5 years. Postoperative CT revealed new bullae [at least one at the apex, segment 6 (S6), or staple line] in both groups. Conclusions: Younger patients with PSP, particularly those aged ≤15 years, showed a clinically relevant tendency toward higher postoperative recurrence and contralateral pneumothorax, warranting careful and prolonged follow-up. Although time-to-event analyses did not demonstrate statistically significant age-related differences in recurrence-free survival, age-specific follow-up strategies for a minimum of 3 years are recommended.