Prevention of postpneumonectomy syndrome in children with prophylactic tissue expander insertion

IntroductionPostpneumonectomy syndrome (PPS) is an often life-threatening complication of pneumonectomy that occurs in up to 15% of children. This occurrence is higher than in adults, presumably because of more elastic tissues in younger patients.MethodsWe present a case series of 4 pediatric patients at Memorial Sloan Kettering Cancer Center, in whom prophylactic tissue expanders were inserted immediately after pneumonectomy.ResultsInsertion of the tissue expander and prevention of PPS was successful in all patients. The presence of the tissue expander did not result in infection in any patient. Our only complication was rupture of the tissue expander in 1 patient, but by the time of removal, a capsule had already formed within the lung and replacement was unnecessary.ConclusionThis case series, although limited in number and follow-up, presents evidence that prophylactic tissue expander insertion appears to be a safe option for children requiring pneumonectomy. Its insertion at the time of pneumonectomy may prevent the devastating complications of PPS. Because it may result in a higher total number of procedures, the benefits must be weighed against the risks of insertion and decisions made for individual patients on a case-by-case basis.