BILATERAL LUNG-VOLUME REDUCTION SURGERY FOR ADVANCED EMPHYSEMA - A COMPARISON OF MEDIAN STERNOTOMY AND THORACOSCOPIC APPROACHES

Study objectives: To compare short-term outcomes following bilateral l ung volume reduction surgery performed by median sternotomy (MS) and v ideo-assisted thoracoscopic surgery (VATS). Methods: Bilateral lung vo lume reduction surgery was performed by MS in 80 patients and by VATS in 40. All patients underwent preoperative assessment with pulmonary f unction testing, arterial blood gas determination, and 6-min walk test (6MWT). Pulmonary function testing and 6MWT were repeated at 3 to 6 m onths postoperatively. Results: The mean age of the VATS group was low er than that of the MS group (59.3 +/- 9.4 vs 62.4 +/- 6.9 years; p = 0.001), but there were no differences in baseline functional parameter s of disease severity (FEV(1), FVC, residual volume [RV], arterial PCO 2, or 6MWT). All patients in both groups were extubated at the complet ion of surgery, but 17.5% of patients in the MS group and 2.5% in the VATS group (p = 0.02) subsequently required reintubation at some point during the postoperative course. Thirty-day operative mortality was 4 .2% for the MS group and 2.5% for the VATS group (p = not significant) . However, total in-hospital mortality was 13.8% for the MS group, whi le it remained 2.5% for the VATS group (p = 0.05). Mortality was large ly confined to patients 65 years of age or older. There was no signifi cant difference in duration of air leaks or length of hospital stay be tween the two groups. Functional outcomes achieved with the two techni ques were similar. Specifically, there was no difference between the t wo groups in mean postoperative FEV(1), FVC, RV, or 6MWT, or in the ma gnitude of change in these parameters over preoperative values. Conclu sions: Bilateral lung volume reduction surgery performed by either MS and VATS approaches leads to similar improvements in pulmonary functio n and exercise tolerance. VATS is associated with a significantly lowe r incidence of respiratory failure and a trend toward decreased in-hos pital mortality and may be the preferred technique, particularly for h igh-risk patients.