PURPOSE: It is beleived that recurrence rate of spontaneous pneumothorax(SP) is higher in women than men. It is also commonly thought that the gender difference is caused by catamenial pneumothorax(CP); specific type of pneumothorax in women of reproductive age. Indeed, as we repotred (Chest, 2009 Oct:136(4):132S), CP has much higher postoperative recurrence rate than non-CP. However, evidences which shows gender differences in clinical outcome according might be lacking. Moreover, it has yet to be fully shown whether catamenial pneumothorax or female gender itself increase the recurrence. Here we analyzed clinicopathological data according to sexes with retrospective design, which indicates female gender itself negatively affects the outcome.
METHODS: To demonstrate the gender difference in response to surgery, we retrospectively reviewed medical records of all the patients reffered for surgical intervention for SP to our hospital during a 5-year period (from Jan. 2004 to Dec. 2009). And to determine whether CP or female sex increase the recurrent episodes, we studied according to clinical presentation (catamenial or non-catamenial).Clinical outcome was evaluated by Pearson’s chi-square test.
RESULTS: There were total of 132 patients; 112 men and 20 women. Mean follow up was 30 months. Current smokers were more common among men than women (53% v.s. 5.6%). In women, catamenial presentation was observed in 4(20%) of 20. Emphysematous bullae was diagnosed in all pathologically-investigated men and 14 of 19 female patients. Pathological findings of the other female patients were a variety of diseases specific to women; diaphragmatic endometriosis, lymphangioleiomyomatosis and pulmonary capillary hemangiomatosis-like foci. Postoperative recurrence rate was significantly higher in women(45%, p< 0.01) than men(8.9%). Non-catamenial pneumothorax recurred more commonly(37.5%) than men with statistical significance(p< 0.01).
CONCLUSION: Our results indicated female gender itself as well as catamenial pneumothorax worsen postoperative clinical course of SP.
CLINICAL IMPLICATIONS: Clinicians should recognize SP in women as a different entity from those in men. Pneumothorax in women should be treated in specialized settings.
DISCLOSURE: Tomohito Saito, No Financial Disclosure Information; No Product/Research Disclosure Information