LUNG REDUCTION SURGERY IN CHRONIC OBSTRUCTIVE LUNG-DISEASE

In the 1960s the promise of the Brantigan lung reduction surgery was s hattered when it was shown that the improvement in air-way conductance drifted back towards the preoperative value over a period of 12 to 18 months. Since then there has been a marked improvement in our underst anding of emphysema, its pathology, and techniques for obtaining image s of the lung. In addition, reliable automated cardiopulmonary and phy siologic testing, advances in critical care medicine, and new pharmaco logic agents have improved patient care. Surgical techniques now allow better control of air leaks and access to anatomic regions not previo usly accessible. The combination of all of the above makes lung reduct ion surgery worth re-examining as a palliative procedure for severely symptomatic patients. Clearly, it is not a panacea but can in some cas es produce dramatic improvements in symptomatology and quality of life . This article presents the available data describing potential mechan isms of improvement and clinical outcomes following lung reduction sur gery. It also outlines areas that need further work, such as patient s election and surgical techniques.