COMPARISON OF SHORT-TERM FUNCTIONAL OUTCOMES FOLLOWING UNILATERAL ANDBILATERAL LUNG-VOLUME REDUCTION SURGERY

Study objectives: To compare short-term functional outcomes following unilateral and bilateral lung volume reduction surgery (LVRS) performe d in patients with advanced emphysema. Methods: LVRS was pet-formed un ilaterally in 32 patients and bilaterally in 119 patients. Pulmonary f unction testing and 6-min walk test (6MWT) were performed preoperative ly and repeated at 3 to 6 months postoperatively, Results: Bilateral L VRS was associated with increased in-hospital mortality (10% vs 0%, p< 0.05) and a higher incidence of postoperative respiratory failure (12. 6% vs 0%; p<0.05) compared with unilateral LVRS. There was no signific ant difference in duration of air leaks between unilateral and bilater al groups, but the mean hospital stay was significantly longer followi ng bilateral LVRS (21.1+/-32.0 days vs 14.2+/-14.0 days; p<0.05). Preo peratively, there was no significant difference between the unilateral and bilateral groups with respect to FEV1, FVC, residual volume, or 6 MWT distance. However, for all of these parameters, the magnitude of i mprovement was significantly greater following bilateral LVRS. Notably , the magnitude of improvement in each parameter following unilateral LVRS exceeded half that following bilateral LVRS, suggesting that func tional outcomes after the unilateral procedure were disproportionate t o the amount of tissue resected. Serial functional assessment of seven patients undergoing staged unilateral procedures (two unilateral proc edures separated in time by at least 3 months) demonstrated somewhat u npredictable responses; failure to achieve a favorable response to the initial procedure did not necessarily portend a similar outcome with the contralateral side, and vise versa. Conclusions: Bilateral LVRS pr oduces a greater magnitude of short-term functional improvement than d oes the unilateral procedure and should be considered the procedure of choice for most patients. Unilateral LVRS should be reserved for pati ents in whom factors contraindicating entrance into one hemithorax exi st.