Management of post-pneumonectomy syndrome using tissue expanders

Video-assisted thoracoscopic surgery for prevention of postpneumonectomy syndrome: A case report

INTRODUCTION

Postpneumonectomy syndrome is a pathological condition consisting in a persistent violation of the function of external respiration caused by the inflection of the trachea and/or the main bronchus and manifested by respiratory insufficiency.

PRESENTATION OF CASE

The article describes a method of video-assisted thoracoscopic surgery for intraoperative prevention of the development of postpneumonectomy syndrome by installing a mesh implant in a patient with central cancer of the right lung.

DISCUSSION

The range of alternatives that have been put forth for the treatment and prevention of the emergence of postpneumonectomy syndrome, on the one hand, demonstrates the relevance of the issue and, on the other, demonstrates the inadequate outcomes of the employed techniques.

CONCLUSION

As a result of a mesh implant that is rigidly linked to the ribs, the preventative strategy we describe reliably prevents mediastinal displacement and doesn't necessitate repeated surgical intervention.

Perioperative considerations for postpneumonectomy syndrome: A case report

Postpneumonectomy syndrome is a rare complication of a pneumonectomy. Patients may experience dyspnea, stridor, recurrent pulmonary infections, or dysphagia due to rotation and shift of the mediastinum. The current intervention of choice involves the placement of a tissue expander in the empty hemithorax to realign the mediastinum. Because this treatment can present with intraoperative anesthetic challenges and requires close monitoring, we present this case to highlight specific concerns that may need to be addressed including difficulties ventilating, complete airway collapse, hemodynamic instability, and pain control perioperatively.

Correction of a postpneumonectomy syndrome with congenital pectus excavatum using Ravitch's procedure and silicone breast implants. Report of a case

•

This paper demonstrates the repair of a severe left sided postpneumonectomy syndrome (PPS), aggravated by a pectus excavatum deformity.

•

The formation of this kind of pathology is very uncommon and therefore this case might be interesting for the readers.

•

We present the successful simultaneous repair of both pathologies.

•

The highlight of this case is the complete documentation of preoperative pathology, intraoperative findings and the postoperative outcome.

Introduction

Mediastinal repositioning and the use of allogenic implants to obliterate the postpneumonectomy space is the main principle of postpneumonectomy syndrome (PPS) correction. We present a rare case with a PPS in combination with a congenital pectus excavatum. As a pectus excavatus deformity reduces retrosternal space, simple repositioning of the heart is impossible unless combined with a sternum elevation.

Presentation of case

Two years after left sided pneumonectomy a 30 year old female was admitted with progressive exertional dyspnea and stridor and not able to do her basic activities. Chest CT-scan and bronchoscopy revealed severe right main bronchus stenosis, compression of hilar vessels and the presence of a pectus excavatum deformity. A single stage operative correction was performed with sternum repositioning by a Ravitch’s procedure, pericardial fixation to the right sternal edge and obliteration of the left thoracic cavity with two silicone breast implants. All complaints disappeared within 48 h.

Discussion

To the best of our knowledge, this is the first report about successful treatment of PPS aggravated by a preexisting pectus excavatum in an adult patient. The durability and migration of the silicone implants and the volume reduction of the pericardial sac during fixation to the sternum continues to remain a concern.

Conclusion

Single stage correction of PPS and pectus deformity is feasible and seems to be the appropriate treatment for both pathologies.

Anesthetic Approach to Postpneumonectomy Syndrome

Postpneumonectomy syndrome is a rare complication in patients who have previously had a pneumonectomy. Over time, the mediastinum may rotate toward the vacant pleural space, which can cause extrinsic airway and esophageal compression. As such, these patients typically present with progressive dyspnea and dysphagia. There is a paucity of reports in the anesthesiology literature regarding the intraoperative anesthetic approach to such rare patients. We present a case of an 18-year-old female found to have postpneumonectomy syndrome requiring thoracotomy with insertion of tissue expanders. Our case report illustrates the complexities involved in the care of these patients with regards to airway management, ventilation concerns, and potential for hemodynamic compromise. This case report underscores the importance of extensive multidisciplinary planning.

Inflammatory State After Intrathoracic Breast Implant Placement for Postpneumonectomy Syndrome

We describe a case of a 16-year-old patient who underwent right pneumonectomy for pulmonary vein atresia and developed postpneumonectomy syndrome. She had an 800-cm³ saline-filled silicone tissue expander placed in the right hemithorax with resolution of her postpneumonectomy syndrome. However, 2 years later, she developed fevers, night sweats, and arthralgias. Her medical workup was negative for vasculitis, inflammatory bowel disease, and infectious etiologies. She underwent tissue expander removal, resulting in resolution of her symptoms. This report describes a case of an inflammatory state created by a tissue expander placed for postpneumonectomy syndrome.

Therapeutic options following pneumonectomy in non-small cell lung cancer

INTRODUCTION

Pneumonectomy can be considered the most appropriate treatment for lung cancer that cannot be removed by lesser resection on.

AREAS COVERED

Therapeutic options following pneumonectomy may be required at least in 3 different scenarios: 1) an early approach due to acute surgical complications 2) a late approach due to chronic surgical complications 3) an integrated radio-chemotherapeutic adjuvant approach for advanced stages. In this review we focused on these three settings with particular emphasis to surgical approach as well as to alternative options. Expert commentary: Pneumonectomy itself does not preclude postoperative additional treatments, if needed, to maximize oncological results and to manage potential short or long term complications. However, as pneumonectomy puts a significant physiological stress on the respiratory and circulatory systems, the benefits and risks of pneumonectomy should be compared with those of alternative, non-resectional treatment modalities.