WOPP- trial: Pulmonary wedge resection plus parietal pleurectomy (WRPP) versus parietal pleurectomy (PP) for the treatment of recurrent primary pneumothorax

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Primary spontaneous pneumothoraces (PSP) represent a significant public health problem, occurring healthy subjects aged under 40 without pre-existing lung disease or precedent medical intervention or trauma. Incidence is 18–28/100 000 per year. The pathomechanism of pulmonary fistula formation resulting in lung collapse is not understood so far. While first-time PSP may be treated successfully by tube-thoracotomy only. Recurrent disease is recommended to be treated by thoracic surgery to restore lung expansion and to prevent de novo lung collapse. Different surgical approaches with varying aggressiveness are inconsistently applied by thoracic surgeons on the basis of lacking evidence-based data. In Germany, both apical wedge resection of the lung and total parietal pleurectomy (WRPP) and the cost-saving partial apical parietal pleurectomy (PP) are established surgical procedures to treat recurrent PSP. In Europe, two clinical practice guidelines published by the British Thoracic Society and several German medical societies in 2010 and 2018, respectively, were not able to assess the significance of lung resection in the course of surgical treatment. In 2013, the investigator-initiated randomized, multi-centric WOPP-trial got off the ground to compare both treatment approaches (NCT01855464)(www.wopp-studie.de). The study randomizes candidates for surgery into one of the two treatment groups after informed consent has been obtained. Patients are followed for 2 years by the participating centers to be able to evaluate the long-term effect of the surgical interventions.