Management of post‐pneumonectomy syndrome using tissue expanders

BACKGROUND Post-pneumonectomy syndrome (PPS) is a rare syndrome characterized by trachea-bronchial stenosis and severe dyspnea. In this study, we retrospectively evaluated the clinical outcomes in patients who underwent placement of tissue expanders for PPS. METHODS Data from patients who underwent placement of tissue expanders for PPS were analyzed for preoperative characteristics, surgical techniques, and postoperative outcomes. Between 1997 and 2014, a total of 10 patients were treated for PPS by tissue expanders. RESULTS The median age of the 10 patients was 45 years (range, 16-70). Four patients had undergone right pneumonectomy, three patients had undergone left pneumonectomy, and three patients had post-pneumonectomy-like syndrome. Preoperatively, seven patients initially received high oxygen therapy for hypoxemia but progressed to respiratory failure, and three patients required mechanical ventilator support. Among these three patients, one required intraoperative extracorporeal membrane oxygenation support because of sudden cardiac arrest during preparation for surgery. The median follow-up was 59.5 months (range, 2-204). The median interval between pneumonectomy and repositioning was 13 months (range, 8-581). Two patients underwent placement of a single tissue expander, and two tissue expanders were placed in eight of the 10 patients. The median volume of tissue expanders inflated with saline was 450 cc (range, 60-850 cc) per tissue expander. There was no perioperative mortality in our study. Complications occurred in four patients (40%). CONCLUSIONS Repositioning of the mediastinum with placement of a saline filled tissue expander for PPS is very effective for the relief of symptoms, with low mortality.