Spontaneous pneumothorax (SPS) is a pneumothorax without trauma or underlying causative factors, and can be divided into primary and secondary pneumothorax. Primary pneumothorax is a more common and frequent condition. The American Association of Thoracic Surgeons and the British Association for Thoracic Surgery guidelines recommend surgical treatment for patients with ipsilateral or contralateral recurrent pneumothorax or persistent air leakage after closed chest drainage. Current surgical options include open-heart surgery and thoracoscopic surgery. Surgical approaches include resection of the lung parenchyma with alveoli and pleural fixation. There are no guidelines for the surgical treatment of spontaneous pneumothorax. To date, there are no large randomized controlled clinical trials (RCTs) to guide thoracic surgeons in choosing the best treatment option. However, it has been reported that thoracoscopic surgery has a higher rate of postoperative pneumothorax recurrence than conventional open surgery. In view of this, Professor Delpy et al. from France conducted a retrospective study to report the factors affecting postoperative complications and recurrence rates of spontaneous pneumothorax, which was published in a recent issue of the European Journal of Cardio-Thoracic Surgery. The study collected data from 7647 patients with primary or secondary spontaneous pneumothorax who underwent surgery from January 2005 to December 2012 in the French national database Epithor? and classified the treatment options by pleural fixation and parenchymal resection. Outcomes included: postoperative thoracic hemorrhage; pulmonary and pleural complications, including atelectasis, pneumonia, pneumothorax, prolonged postoperative assisted ventilation, acute respiratory distress syndrome, and persistent pulmonary air leak; length of hospital stay; and recurrence, requiring rethoracic closed drainage or secondary pneumothorax after surgical treatment. The primary study endpoints were divided into respiratory complications and postoperative thoracic hemorrhage. Respiratory complications included pulmonary and thoracic complications, including bronchoscopically confirmed atelectasis, lung-related disease, pneumothorax, mechanical ventilation lasting more than 2 days, acute respiratory distress syndrome (ARDS), and air leak lasting more than 7 days. Postoperative bleeding was defined as a hemothorax requiring surgical intervention or blood transfusion. Secondary study endpoints were length of stay and pneumothorax recurrence. The study found higher rates of lung parenchymal resection (62.4% versus 80%) and lower rates of pleural fixation (93% versus 77.5%), lower rates of postoperative respiratory complications (12% versus 8.2%) and postoperative pleural hemorrhage (2.3% versus 1.4%), and shorter hospital stays (16 versus 9 days) in the thoracoscopic group compared with the open-chest group. The recurrence rate was 1.8% in the open-chest group compared with 3.8% in the lumpectomy group. The median time to recurrence was 3 months. The study also found that patients who underwent open thoracotomy were older, had a lower smoking history, had a higher BMI, lower ASA scores, and more coexisting underlying conditions than those in the lumpectomy group. Patients undergoing open thoracotomy had a higher rate of prior chest disease and history of chest surgery compared to the lumpectomy group. The thoracoscopic group was associated with less use of mechanical pleural fixation, lower respiratory complications, lower postoperative thoracic hemorrhage, and a higher recurrence rate. Their higher recurrence rate may be related to the different pleural fixation used, with chemical pleural fixation more commonly used in thoracoscopic surgery, which may be less effective than mechanical pleural fixation and lead to a higher recurrence rate after lumpectomy. This study showed that thoracoscopic treatment of patients with spontaneous pneumothorax had a higher rate of lung parenchyma resection and a lower rate of intraoperative pleural fixation and reduced the incidence of postoperative respiratory complications and postoperative thoracic hemorrhage, as well as shortening the length of stay of patients. However, this study is retrospective and may be inexpensive, so the best option for surgical treatment of spontaneous pneumothorax needs to be confirmed in future prospective studies.