ABSTRACT
The post-pneumonectomy syndrome is a rare complication consisting of rotation and herniation of the mediastinal structures, the remaining lung and the respective bronchi, into the contralateral hemithorax. This situation may produce symptomatic airway obstruction and varies in its presentation and severity. We describe one case of right and one of left pneumonectomy syndrome as well as one case of post-lobectomy syndrome. We review the literature on the pathophysiology, the clinical, radiological and bronchoscopic characteristics of this rare entity and discuss all available therapeutic alternatives.
Subject(s)
Airway Obstruction/diagnostic imaging , Bronchomalacia/diagnostic imaging , Lung Neoplasms/surgery , Pneumonectomy/adverse effects , Adult , Aged , Airway Obstruction/therapy , Bronchomalacia/physiopathology , Bronchomalacia/therapy , Bronchoscopy/methods , Cough/diagnosis , Cough/etiology , Dyspnea/diagnosis , Dyspnea/etiology , Fatal Outcome , Female , Humans , Male , Noninvasive Ventilation/methods , Postoperative Complications/epidemiology , Silicones , Stents/adverse effects , Treatment OutcomeABSTRACT
BACKGROUND: Although interventional management of malignant central airway obstruction (mCAO) is well established, its impact on survival and quality of life (QoL) has not been extensively studied. AIM: We prospectively assessed survival, QoL and dyspnea (using validated EORTC questionnaire) in patients with mCAO 1 day before interventional bronchoscopy, 1 week after and every following month, in comparison to patients who declined this approach. Material/Patients/Methods: 36 patients underwent extensive interventional bronchoscopic management as indicated, whereas 12 declined. All patients received full chemotherapy and radiotherapy as indicated. Patients of the 2 groups were matched for age, comorbidities, type of malignancy and level of obstruction. Follow up time was 8.0±8.7 (range 1-38) months. RESULTS: Mean survival for intervention and control group was 10±9 and 4±3 months respectively (p=0.04). QoL improved significantly in intervention group patients up to the 6(th) month (p<0.05) not deteriorating for those surviving up to 12 months. Dyspnea decreased in patients of the intervention group 1 month post procedure remaining reduced for survivors over the 12th month. Patients of the control group had worse QoL and dyspnea in all time points. CONCLUSIONS: Interventional management of patients with mCAO, may achieve prolonged survival with sustained significant improvement of QoL and dyspnea.
