Two years' outcome of lung volume reduction surgery in different morphologic emphysema types

Background. Lung volume reduction surgery (LVRS) improves dyspnea, pulmonar y function, and quality of life in selected patients with severe emphysema. We investigated the role of emphysema morphology in 37 patients as an outc ome predictor for up to 2 years after operation. Methods. Patients selected for bilateral thoracoscopic LVRS were divided, a ccording to a simplified emphysema morphology classification, into three gr oups (homogeneous, moderately heterogeneous, and markedly heterogeneous) ba sed on a preoperative chest computed tomogram. Pulmonary function, walking distance, and dyspnea were assessed. Results. Functional improvement after LVRS was best in markedly heterogeneo us emphysema with an increase from preoperative forced expiratory volume in 1 second of 31% +/- 2% (mean +/- standard error of the mean) to 52% +/- 4% of predicted postoperatively. It was significantly higher than in homogene ous emphysema (from 26% +/- 1% to 38% +/- 2% predicted) and in intermediate ly heterogeneous emphysema (from 29% +/- 2% to 44% +/- 45% predicted). At 2 4 months postoperatively, forced expiratory volume in 1 second and dyspnea score continued to be significantly better than preoperative levels in all three morphologic groups. The survival rate was highest in patients with ma rkedly heterogeneous emphysema. Conclusions. Functional and subjective improvements were maintained after L VRS for at least 24 months in patients with heterogeneous or homogeneous em physema type. (C) 1999 by The Society of Thoracic Surgeons.