Results of lung-volume reduction surgery in end-stage lung emphysema

Background: Surgical treatment of diffuse, nonbullous emphysema was first d escribed by Brantigan et al. in 1957 and was reintroduced by Cooper et al. in 1995 as lung-volume reduction surgery (LVRS). Meanwhile it has become an internationally established procedure in the treatment of lung emphysema. We report our results after LVRS in 91 patients. Methods: Between September 1994 and August 1998 LVRS was performed through median sternotomy (n = 15) , videoendoscopy (n = 49), thoracotomy (n = 18) or combined video endoscopy on one side and thoracotomy on the other (n = 9) in 91 patients (aged 33-8 0 years; mean 56,4 years). All patients showed progression of severe dyspne a despite maximum medical and physical therapy. Results: Perioperative mort ality was 5.5 % (5 patients). Seventy-five percent of the patients showed s ignificant functional improvement [postoperatively above 120 % of the preop erative forced expiratory volume in Is (FeV1)]. Mean FeV1 significantly inc reased by 28.6% from 25.5 +/- 1.2 % predicted (% p) preoperatively to 32.8 +/- 1.9 % p during the first 6 months postoperatively (p < 0.005). Furtherm ore, the mean RV was reduced from 320.3 +/- 7.9 % p preoperatively to 248.4 +/- 7.5 % p 6 months postoperatively and mean TLC from 140.2 +/- 2.4 % p t o 126.1 +/- 2.1 % p (p < 0.005). Intrinsic PEEP decreased significantly fro m 5.1 +/- 0.4 cm H2O preoperatively to 2.3 +/- 0.3 cm H2O postoperatively ( p < 0.05). Conclusion: LVRS is an excellent therapeutic option for selected patients with severe emphysema and additional signs of severe hyperinflati on. It results in significant postoperative functional improvement and mark ed increase in quality of life. The long-term benefit of LVRS remains to be defined.