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Late Effects

Respiratory

 

Surgery

 

Surgical Resection

Lobectomy, or rarely pneumonectomy, may be performed in children for:

  • Resection of primary or secondary tumours in the lung
  • Removal of infected areas of lung (particularly fungal infection).

Lung resection is usually well tolerated in children because of the increased potential for lung growth (Kreisel 2004)

 

Normal Postnatal Lung Growth (Kreiesel 2004, (38)

The number of alveoli increases from 20 x106 at birth to 300 x 106 at age 8.

The most rapid increase occurs in the first 3 years.

There is no increase in the number of alveoli after age 8.

Lung volume doubles between the ages of 8-25 years due to an increase in the volume of individual alveoli.

 

Lobectomy

After lobectomy there is some compensatory growth of the remaining lung.

Resection of the upper lobes results in more vigorous compensatory growth than lower lobe resection24

 

Pneumonectomy

Preservation of total lung capacity decreases as the age of the patient at the time of pneumonectomy increases ie younger patients have more compensatory lung growth than older patients.25

Total lung capacity at follow up has been shown to be:25

  • 96% of predicted value in patients younger than 5 years at pneumonectomy
  • 85% of predicted value in patients aged 6-20 at pneumonectomy
  • 70% of predicted value in patients aged 31-40 at pneumonectomy

Post pneumonectomy syndrome:

  • May occur in children when there is a shift of the mediastinal structures into the resection cavity resulting in obstruction of the bronchi.
  • May result in:
  • Airway obstruction
  • Progressive hyperinflation of residual aerated lung
  • Increased risk of infection.
  • Can usually be prevented by anterior pexy of the mediastinal structures to prevent shift.23

 

Musculoskeletal Development after Thoracotomy

  • Scoliosis may occur post thoracotomy due to muscular imbalance because of division, denervation or interruption of blood supply to the thoracic muscles.
  • Other long term musculoskeletal complications of thoracotomy and lung resection include:
  • Deformities of the hemithorax
  • Elevation of the shoulder
  • Limitation of arm abduction23

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