K. Robert Shen, John C. Wain, Cameron D. Wright, Hermes C. Grillo, Douglas J. Mathisen; Massachusetts General Hospital, Boston, MA
Objective: Postpneumonectomy syndrome (PPS) is a rare syndrome of dynamic airway obstruction caused by extreme rotation and shift of the mediastinum after pneumonectomy, resulting in symptomatic central airway compression. We have treated this syndrome by mediastinal repositioning and placement of saline-filled prostheses into the pneumonectomy space. There is a paucity of outcome data for patients treated surgically, with only a single series of eleven patients previously reported. We analyzed our recent experience with treatment of this syndrome in order to report on the short and long-term outcomes and quality of life (QOL) assessment of the largest series ever reported of patients treated by mediastinal repositioning.Methods: Records were reviewed of all patients who underwent mediastinal repositioning for PPS from January 1992-June 2006. Long-term health related QOL was assessed by administration of the St. George's Respiratory Questionnaire
Results: There were 18 patients (15 women and 3 men), median age was 44 years (range 14-67 years). 13 patients had undergone right and 5 had undergone left pneumonectomy. None of the patients who developed PPS after left pneumonectomy had a right sided aortic arch. 5 patients had undergone pneumonectomy in childhood (age<13 years). Median interval between pneumonectomy and mediastinal repositioning was 7.5 years (range 1.1-54.8 years). Median follow-up was 32 months (range 4-143 months). Operative mortality was 5.6% (1/18). Complications occurred in 5 patients (27.8%): pneumonia(3), acute respiratory distress syndrome(2). Median hospitalization was 6 days (range 3-155 days). 77% (10/13) of patients reported significant improvement in their breathing and overall state of health after surgery. 15.4% (2/13) were somewhat better, and 7.7% (1/13) had no improvement. No patients were worse after surgery. All patients who reported improvement in their symptoms after surgery remained symptomatically improved at the time of the QOL assessment. 92.3% (12/13) were not at all or only slightly limited in their social activities due to breathing problems. 84.6% (11/13) were not at all or only slightly limited in their ability to work as a result of their physical health.
Conclusion: Repositioning of the mediastinum with placement of prostheses for PPS can be performed with low mortality and morbidity. Surgical repositioning provides immediate and lasting symptomatic relief to patients who develop PPS.
Back to Annual Meeting
Back to Program Outline
