Long-Term Efficacy of Conservative Management Versus Minimally Invasive Surgery for Pneumothorax: A Systematic Review and Meta-Analysis

AIM: Pneumothorax is a prevalent thoracic disorder, with management strategies primarily consisting of conservative treatment and minimally invasive surgery. However, their long-term efficacy remains controversial. This study conducted a systematic review and meta-analysis to compare clinical outcomes between these two approaches. METHODS: A comprehensive search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) and non-randomized controlled trials published between 1 January 2000 and 31 January 2025. Studies comparing total complications, recurrence rate during hospitalization, and overall recurrence rate between treatment groups were included. Fixed- or random-effects models were applied for meta-analysis. Begg's test was applied to assess publication bias, and sensitivity analysis was performed to evaluate model robustness. RESULTS: A total of nine studies were included in the meta-analysis. Compared to conservative treatment, video-assisted thoracoscopic surgery (VATS) significantly reduced the recurrence rate during hospitalization [odds ratio (OR) = 0.23, 95% CI (0.12–0.43), p < 0.00001] and the overall recurrence rate [OR = 0.16, 95% CI (0.08–0.31), p < 0.00001]. However, no statistically significant difference was found between the groups in terms of complication rate (p = 0.79). Additionally, Begg's test confirmed no significant publication bias (p > 0.05). Subgroup analysis indicated that pneumothorax type may contribute to the observed heterogeneity. CONCLUSIONS: VATS reduces both the short-term recurrence rate during hospitalization and the overall recurrence rate in patients with pneumothorax, offering a clinical advantage in preventing early relapse. Individualized treatment strategies tailored to patient characteristics and pneumothorax type remain essential. Additional high-quality studies are needed to clarify its long-term efficacy.