Pleural Abrasion Favored for Faster Recovery; Pleurectomy Reduces Recurrence Risk in Spontaneous Pneumothorax: Study
China: Researchers have found in a new study that pleural abrasion offers better perioperative outcomes, making it ideal for patients seeking rapid recovery or those with limited surgical tolerance. In contrast, parietal pleurectomy, though associated with a heavier perioperative burden and higher risk of postoperative hemorrhage, effectively lowers recurrence rates in patients with recurrent or complex pneumothorax. Postoperative complication rates are similar for both techniques.
The study, published in BMC Surgery by Kai Yang and colleagues from the First Clinical Medical School, Gansu University of Chinese Medicine, Lanzhou, aimed to compare the perioperative efficacy and safety profiles of parietal pleurectomy and pleural abrasion when combined with bullectomy for treating spontaneous pneumothorax. This condition, characterized by air accumulation in the pleural cavity leading to lung collapse, is typically managed through procedures that restore lung expansion and prevent recurrence. While video-assisted thoracoscopic surgery (VATS) bullectomy with pleural fixation has become standard practice, the choice of fixation method—pleurectomy or abrasion—remains debated.
To address this, the researchers conducted a comprehensive meta-analysis, systematically reviewing studies from PubMed, Web of Science, Embase, and the Cochrane Library up to February 2025. Fifteen studies encompassing 2,732 patients met the inclusion criteria. Statistical analysis was performed using Review Manager 5.3 and Stata 16MP, and study quality was assessed through the Cochrane risk-of-bias tool and the Newcastle–Ottawa Scale.
The analysis revealed the following findings:
- Postoperative pain levels were comparable between the pleural abrasion and parietal pleurectomy groups.
- Patients who underwent pleural abrasion had shorter operation times.
- Pleural abrasion was linked to reduced intraoperative blood loss.
- The total postoperative drainage volume was lower in the pleural abrasion group.
- Patients in the pleural abrasion group experienced shorter drainage duration.
- Hospital stay was shorter for patients treated with pleural abrasion.
- Parietal pleurectomy carried an almost fourfold higher risk of postoperative hemorrhage.
- No significant differences were observed between the two techniques in terms of postoperative atelectasis, air leakage, or pulmonary infection.
- Parietal pleurectomy significantly lowered the long-term recurrence rate of pneumothorax compared to pleural abrasion.
The authors noted that while pleurectomy imposes greater perioperative stress and prolongs hospitalization, its ability to minimize recurrence makes it a favorable choice for patients with recurrent or complicated pneumothorax. Conversely, pleural abrasion’s less invasive nature and quicker recovery profile make it more suitable for patients prioritizing rapid rehabilitation or those with limited tolerance for extensive surgery.
However, the researchers acknowledged several limitations, including variations in surgical expertise, differences in recurrence definitions, inconsistent follow-up durations, and limited data for certain clinical indicators. Moreover, the predominance of retrospective studies underscores the need for future large-scale randomized controlled trials to confirm these findings.
According to the meta-analysis, both parietal pleurectomy and pleural abrasion are viable surgical options for spontaneous pneumothorax. While pleural abrasion offers superior short-term outcomes, pleurectomy remains more effective in reducing recurrence. The optimal approach, the authors emphasized, should be tailored to individual patient profiles and clinical circumstances.
Reference:
Yang, K., Wang, C., Wang, Q. et al. A meta-analysis of efficacy and safety of parietal pleurectomy versus pleural abrasion in treating spontaneous pneumothorax. BMC Surg 25, 464 (2025). https://doi.org/10.1186/s12893-025-03157-4
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