LUNG-VOLUME REDUCTION SURGERY - CASE SELECTION, OPERATIVE TECHNIQUE, AND CLINICAL-RESULTS

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.