Postpneumonectomy Syndrome: Results of mediastinal repositioning vs. stent placement

Background: Postpneumonectomy syndrome (PPS) is a late complication of pneumonectomy characterized by mediastinal shift and bronchial compression. It is most common following right pneumonectomy but is also seen left pneumonectomy. It can be treated with mediastinal repositioning and tissue expander placement in the postpneumonectomy space, but there is some interest in less invasive modalities. Endobronchial stent placement may be an option. We looked at our experience treating PPS with these two modalities. Methods: All patients with PPS treated with mediastinal repositioning/tissue expander placement or bronchial stenting at our institution from 1991 to 2005 were reviewed. Results: Mean age at the time of pneumonectomy was 45 years. Mean follow-up was 33 months. Six patients underwent tissue expander placement. They had relief of symptoms with the following complications: wound infection, atrial fibrillation, expander leak and esophageal dysmotility. Two patients underwent silastic stent placement with immediate resolution of symptoms, however they suffered from frequent mucous plugging, stent migration, and granulation tissue formation requiring repeat bronchoscopic treatment and stent replacement. Conclusions: Mediastinal repositioning with tissue expander placement provides durable relief of symptoms. Endobronchial stenting is a less invasive treatment option for PPS, however patients require close follow-up due to a high complication rate. Need for frequent bronchoscopy often emergently present serious limitations in this small group.