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Post-pneumonectomy syndrome: a systematic review of the current evidence and treatment options
OBJECTIVES: Post-pneumonectomy syndrome (PPS) is rare and predominantly characterised by dynamic airway obstruction due to mediastinal rotation at any time point following pneumonectomy. The objective of this systematic review was to identify the optimal treatment strategy for PPS based on subjectiv...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10084598/ https://www.ncbi.nlm.nih.gov/pubmed/37038182 http://dx.doi.org/10.1186/s13019-023-02278-2 |
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author | Christodoulides, Natasha Fitzmaurice, Gerard J. Bukowska, Irmina O’Rhaillaigh, Eoin Toale, Conor Griffin, Michael Redmond, Karen C. |
author_facet | Christodoulides, Natasha Fitzmaurice, Gerard J. Bukowska, Irmina O’Rhaillaigh, Eoin Toale, Conor Griffin, Michael Redmond, Karen C. |
author_sort | Christodoulides, Natasha |
collection | PubMed |
description | OBJECTIVES: Post-pneumonectomy syndrome (PPS) is rare and predominantly characterised by dynamic airway obstruction due to mediastinal rotation at any time point following pneumonectomy. The objective of this systematic review was to identify the optimal treatment strategy for PPS based on subjective symptomatic relief, objective radiological imaging, and treatment durability. METHODS: A systematic review was performed up to and including February 2022 based on the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” guidelines. All studies that presented the management of symptomatic patients > 16 years of age with radiologically confirmed PPS were included. The primary outcome was the identification of the optimal treatment strategy and the secondary outcome was durability of the treatment. The Oxford Centre for Evidence Based Medicine level was assigned to each study. RESULTS: A total of 330 papers were identified and reviewed; 41 studies met the inclusion criteria. Data including patient demographics, indication for initial pneumonectomy, presenting symptoms, management approach, outcomes, and follow-up were assessed and analysed. Management approaches were divided into three categories: (a) mediastinal repositioning using implant prostheses; (b) endobronchial stenting; (c) other corrective procedures. One hundred and four patients were identified in total and of those, 87 underwent mediastinal repositioning with insertion of a prosthetic implant. Complications included over- or under-filling of the prosthesis (8.5%) and implant leakage (8.9%). CONCLUSION: Management of PPS using a prosthetic implant to reposition the mediastinum is the treatment of choice. Key adjuncts to optimise surgical approach and minimise complications include pre-operative CT volumetric analysis to guide implant size and intra-operative transoesophageal echocardiography to guide mediastinal repositioning. |
format | Online Article Text |
id | pubmed-10084598 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-100845982023-04-11 Post-pneumonectomy syndrome: a systematic review of the current evidence and treatment options Christodoulides, Natasha Fitzmaurice, Gerard J. Bukowska, Irmina O’Rhaillaigh, Eoin Toale, Conor Griffin, Michael Redmond, Karen C. J Cardiothorac Surg Review OBJECTIVES: Post-pneumonectomy syndrome (PPS) is rare and predominantly characterised by dynamic airway obstruction due to mediastinal rotation at any time point following pneumonectomy. The objective of this systematic review was to identify the optimal treatment strategy for PPS based on subjective symptomatic relief, objective radiological imaging, and treatment durability. METHODS: A systematic review was performed up to and including February 2022 based on the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” guidelines. All studies that presented the management of symptomatic patients > 16 years of age with radiologically confirmed PPS were included. The primary outcome was the identification of the optimal treatment strategy and the secondary outcome was durability of the treatment. The Oxford Centre for Evidence Based Medicine level was assigned to each study. RESULTS: A total of 330 papers were identified and reviewed; 41 studies met the inclusion criteria. Data including patient demographics, indication for initial pneumonectomy, presenting symptoms, management approach, outcomes, and follow-up were assessed and analysed. Management approaches were divided into three categories: (a) mediastinal repositioning using implant prostheses; (b) endobronchial stenting; (c) other corrective procedures. One hundred and four patients were identified in total and of those, 87 underwent mediastinal repositioning with insertion of a prosthetic implant. Complications included over- or under-filling of the prosthesis (8.5%) and implant leakage (8.9%). CONCLUSION: Management of PPS using a prosthetic implant to reposition the mediastinum is the treatment of choice. Key adjuncts to optimise surgical approach and minimise complications include pre-operative CT volumetric analysis to guide implant size and intra-operative transoesophageal echocardiography to guide mediastinal repositioning. BioMed Central 2023-04-10 /pmc/articles/PMC10084598/ /pubmed/37038182 http://dx.doi.org/10.1186/s13019-023-02278-2 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Review Christodoulides, Natasha Fitzmaurice, Gerard J. Bukowska, Irmina O’Rhaillaigh, Eoin Toale, Conor Griffin, Michael Redmond, Karen C. Post-pneumonectomy syndrome: a systematic review of the current evidence and treatment options |
title | Post-pneumonectomy syndrome: a systematic review of the current evidence and treatment options |
title_full | Post-pneumonectomy syndrome: a systematic review of the current evidence and treatment options |
title_fullStr | Post-pneumonectomy syndrome: a systematic review of the current evidence and treatment options |
title_full_unstemmed | Post-pneumonectomy syndrome: a systematic review of the current evidence and treatment options |
title_short | Post-pneumonectomy syndrome: a systematic review of the current evidence and treatment options |
title_sort | post-pneumonectomy syndrome: a systematic review of the current evidence and treatment options |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10084598/ https://www.ncbi.nlm.nih.gov/pubmed/37038182 http://dx.doi.org/10.1186/s13019-023-02278-2 |
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