Long-term survival after thoracoscopic lung volume reduction: A multiinstitutional review

Background. It has been suggested that bilateral thoracoscopic lung volume reduction (BTLVR) yields significantly better long-term survival than unila teral thoracoscopic lung volume reduction (UTLVR). Methods. All perioperative data were collected at the time of the procedure . Follow-up data were obtained during office visits or by telephone. Results. A total of 673 patients underwent thoracoscopic LVR: 343 had eithe r simultaneous or staged BTLVR and 330, UTLVR. As of July 1998, follow-up w as available on 667 (99%) of the 673 patients with a mean follow-up of 24.3 months. The patients in the BTLVR group were significantly younger (62.6 /- 8.0 years versus 65.4 +/- 8.1 years; p < 0.0001), had a higher preoperat ive arterial oxygen tension (69.7 +/- 12 mm Hg versus 65.3 +/- II mm Hg; p < 0.0001), and had a superior preoperative 6-minute walk performance (279.9 +/- 93.6 m [933 +/- 312 feet] versus 244.5 +/- 101.4 m [815 +/- 338 feet] p < 0.0001). There was no difference in the operative mortality rate betwee n the two groups (UTLVR, 5.1%, and BTLVR, 7%). Actuarial survival rates for the UTLVR group at 1 year, 2 years, and 3 years were 86%, 75%, and 69%, re spectively versus 90%, 81%, and 74%, respectively, for the BTLVR group (p = not significant). Conclusions. Contrary to previous reports, survival after BTLVR was not sup erior to that after UTLVR even though the former group appeared to have a l ower risk preoperatively because of younger age, higher arterial oxygen ten sion, more advantageous anatomy, and better functional status. Despite thor acoscopic LVR, the actuarial mortality rate approached 30% at 3 years, and this calls into question whether this procedure offers any survival advanta ge to patients with end-stage emphysema. (C) 1999 by The Society of Thoraci c Surgeons.