Tm. Daniel et al., LUNG-VOLUME REDUCTION SURGERY - CASE SELECTION, OPERATIVE TECHNIQUE, AND CLINICAL-RESULTS, Annals of surgery, 223(5), 1996, pp. 526-531
Objective A clinical study was undertaken to define optimal preoperati
ve strategies and intraoperative techniques that would result in the l
east morbidity and maximum physiologic improvement in patients with en
d-stage emphysema selected for lung volume reduction surgery, Backgrou
nd Lung volume reduction surgery recently has been advocated as an alt
ernative or a bridge to lung transplantation for patients with end-sta
ge chronic obstructive pulmonary disease. The risks, benefits, and lon
g-term results have not been clarified. Methods Twenty-six patients un
derwent lung volume reduction surgery with a 3-month follow-up on 17 p
atients. Preoperative acid postoperative changes in pulmonary function
parameters, quality of life, and oxygen requirement were analyzed. Th
e value of preoperative localization of diseased lung segments and how
this affects intraoperative resection is addressed. Results Forty-nin
e percent improvement in FEV(1) (forced expiratory volume in 1 second)
and 23% improvement in FVC (forced vital capacity) were seen after lu
ng volume reduction surgery. Supplemental oxygen requirement was decre
ased and 79% of patients reported a much better quality of life. Morta
lity was 3.8% and air leak morbidity was 18%. Conclusions Lung volume
reduction surgery can predictably improve objective and subjective pul
monary function in selected patients with end-stage emphysema with low
morbidity and mortality. Careful patient selection, accurate preopera
tive localization of diseased target areas, skilled anesthetic techniq
ue, meticulous operative approach, and intense postoperative support a
re essential to achieve favorable results.