Lung volume reduction surgery (LVRS) for chronic obstructive pulmonary disease (COPD) with underlying severe emphysema

Background-Lung volume reduction surgery (LVRS) has recently re-emerged as a surgical option for the treatment of end stage chronic obstructive pulmon ary disease (COPD) due to underlying severe emphysema. Advocates of LVRS cl aim that it represents a significant breakthrough in the management of this challenging group of patients while sceptics point to uncertainty about th e effectiveness of the operation. Methods-A systematic review was conducted of the evidence on the effects of LVRS in patients with end stage COPD secondary to severe emphysema. Results-The most rigorous evidence on the effectiveness of LVRS came from c ase series. Seventy five potentially relevant studies were identified and 1 9 individual series met the methodological criteria for inclusion. The patt ern of results was consistent across individual studies despite a significa nt degree of clinical heterogeneity. Significant short term benefits occurr ed across a range of outcomes which appeared to continue into the longer te rm. Physiological improvements were matched by functional and subjective im provements. Early mortality rates were low and late mortality rates compare d favourably with those of the general COPD population. However, the entire research base for the intervention is subject to the limitations of study designs without parallel control groups. Conclusions-LVRS appears to represent a promising option in the management of patients with severe end stage emphysema. However, until the results of ongoing clinical trials are available, the considerable uncertainty that ex ists around the effectiveness and cost effectiveness of the procedure will remain.