Pneumothorax: surgery or patience?

By Ana Espino | Published on December 11, 2025 | 3 min read


Pneumothorax is a common thoracic condition caused by the presence of air in the pleural cavity. It can be primary—occurring in individuals without underlying lung disease—or secondary, linked to conditions such as COPD. Treatment mainly relies on two approaches: conservative management (oxygen therapy, aspiration) and minimally invasive surgery (VATS). Although conservative treatment is less invasive, it carries a high recurrence rate. Conversely, VATS appears more effective at preventing relapses, but its long-term efficacy remains controversial.  

The optimal therapeutic strategy for pneumothorax remains controversial today, particularly because there is no clear consensus depending on the type of pneumothorax (primary or secondary). This uncertainty represents a major limitation in the standardization of clinical management. Added to this is considerable variability among international guidelines and a lack of robust long-term data, both of which complicate day-to-day clinical decision making.  

In this context, this study was designed to compare the long-term effectiveness of conservative management versus minimally invasive surgery (VATS), by assessing recurrence rates, complications, and the influence of pneumothorax type on outcomes.    

Does minimally invasive surgery really change the game?  

The study included nine trials. Patients presented with pneumothorax. Two strategies were compared: minimally invasive surgery (VATS) and conservative management. Each study required a follow-up period of at least six months.  

The results show that the recurrence rate during hospitalization is significantly lower after VATS, with an odds ratio of 0.23 (p < 0.00001). Overall recurrence—including post-hospital follow-up—is also reduced in the VATS group (OR = 0.16; p < 0.00001). In contrast, no significant difference exists between the two groups regarding post-treatment complications (p = 0.79). Subgroup analysis further indicates that the effectiveness of VATS is particularly pronounced in patients with primary pneumothorax.    

A step toward personalized pneumothorax treatment  

Pneumothorax is a common respiratory condition caused by the presence of air in the pleural cavity. It may be primary (without apparent cause) or secondary (linked to a lung disease). Management remains complex, especially due to the high risk of recurrence, particularly after conservative treatment. Today, there is no clear consensus on the best therapeutic strategy, and recommendations vary across countries. The lack of solid long-term data and the difficulty of tailoring treatments to pneumothorax type or patient profile complicate clinical decision making.  

In this context, the aim of this study was to compare the long-term efficacy of minimally invasive surgery with that of conservative management, evaluating recurrence rates, complications, and the impact of pneumothorax type on outcomes.  

The results show that VATS significantly reduces recurrence rates without increasing the risk of postoperative complications, making it a promising therapeutic option, particularly for primary pneumothorax. These findings highlight the need for prospective, multicenter, long-term studies, including more detailed analyses of patients’ clinical characteristics—such as age, presence of COPD, or other comorbidities—in order to refine recommendations and optimize personalized treatment strategies.   

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