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Background <p>Catamenial pneumothorax is a rare manifestation of thoracic endometriosis syndrome and is associated with a high risk of recurrence despite surgical intervention. Increasingly, multimodal strategies combining thoracic surgery with adjunctive hormonal therapy have been put in place as standard practice however, optimal management remains uncertain.</p> Methods <p>A systematic review of the literature was conducted using MEDLINE/PubMed, Scopus, CENTRAL, Google Scholar, SciSpace, and the Cochrane Library for studies published between January 2000 and December 2025. Studies reporting outcomes of surgical management for catamenial pneumothorax were included. Data was extracted on patient characteristics, surgical techniques (diaphragmatic and pleural interventions), use of postoperative hormonal therapy, and recurrence rates.</p> &#xa0;Results <p>Analysis of 37 studies encompassing over 1,800 patients suggests that treatment approach is a major determinant of outcomes. Meta-analysis demonstrates a pooled recurrence rate of 17.3% with postoperative hormonal therapy compared to 54.2% without (<i>p</i> &lt; 0.01) [<CitationRef CitationID="CR1">1</CitationRef>], with younger age independently associated with higher recurrence risk. Diaphragmatic intervention is critical to reducing recurrence, with studies reporting 12.5% recurrence when diaphragmatic surgery is combined with pleurodesis versus 100% with pleurodesis alone [<CitationRef CitationID="CR15">15</CitationRef>]. Diaphragm resection has been identified as an independent protective factor against recurrence (HR 0.16; 95% CI: 0.03–0.77; <i>p</i> = 0.022) [<CitationRef CitationID="CR5">5</CitationRef>].</p> Conclusions <p>The available evidence supports a multimodal approach to the management of catamenial pneumothorax. Comprehensive thoracoscopic surgery addressing diaphragmatic pathology, combined with pleurodesis and postoperative hormonal therapy, is consistently associated with reduced recurrence. Given the observational nature of the available data, these findings should be interpreted with appropriate caution and highlight the need for prospective, collaborative studies.</p>

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Surgical management of catamenial pneumothorax: a systematic review

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月30日

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  • Andrew Mekhail,
  • Joseph Kilby,
  • Sam Macalister,
  • Pravin Chidambaram Manivannan,
  • Michael Seitz

摘要

Background

Catamenial pneumothorax is a rare manifestation of thoracic endometriosis syndrome and is associated with a high risk of recurrence despite surgical intervention. Increasingly, multimodal strategies combining thoracic surgery with adjunctive hormonal therapy have been put in place as standard practice however, optimal management remains uncertain.

Methods

A systematic review of the literature was conducted using MEDLINE/PubMed, Scopus, CENTRAL, Google Scholar, SciSpace, and the Cochrane Library for studies published between January 2000 and December 2025. Studies reporting outcomes of surgical management for catamenial pneumothorax were included. Data was extracted on patient characteristics, surgical techniques (diaphragmatic and pleural interventions), use of postoperative hormonal therapy, and recurrence rates.

 Results

Analysis of 37 studies encompassing over 1,800 patients suggests that treatment approach is a major determinant of outcomes. Meta-analysis demonstrates a pooled recurrence rate of 17.3% with postoperative hormonal therapy compared to 54.2% without (p < 0.01) [1], with younger age independently associated with higher recurrence risk. Diaphragmatic intervention is critical to reducing recurrence, with studies reporting 12.5% recurrence when diaphragmatic surgery is combined with pleurodesis versus 100% with pleurodesis alone [15]. Diaphragm resection has been identified as an independent protective factor against recurrence (HR 0.16; 95% CI: 0.03–0.77; p = 0.022) [5].

Conclusions

The available evidence supports a multimodal approach to the management of catamenial pneumothorax. Comprehensive thoracoscopic surgery addressing diaphragmatic pathology, combined with pleurodesis and postoperative hormonal therapy, is consistently associated with reduced recurrence. Given the observational nature of the available data, these findings should be interpreted with appropriate caution and highlight the need for prospective, collaborative studies.