Relationship between amount of lung resected and outcome after lung volumereduction surgery

Background. Lung volume reduction surgery (LVRS) is being actively investig ated for palliative treatment of severe emphysema. Considerable focus is di rected toward patient selection and outcomes of LVRS. However, there is lit tle information available regarding surgical methods to guide optimal exten t of resection. We hypothesized that acute improvement and long-term surviv al after bilateral staple LVRS would be related to the extent of tissue res ected. Methods. The relationship between acute improvement in forced expiratory vo lume in 1 second and forced vital capacity was examined as a function of th e total grams of lung tissue resected in 237 patients who underwent bilater al staple LVRS by a single group of surgeons. Overall survival was assessed based on extent of resection by quartiles of tissue weight resected using KaplanMeier survival methods. Results. Improvement in forced expiratory volume in 1 second and forced vit al capacity correlated with extent of tissue resected (p < 0.01), although there was considerable variability to individual response (r = 0.3). In con trast, there was no apparent relationship between the amount of tissue rese cted and overall postoperative survival (p = 0.7). Conclusions. There is a correlation between the amount of tissue resected a nd improvement in forced expiratory volume in 1 second and forced vital cap acity after bilateral staple LVRS, with generally greater postoperative imp rovement after larger volume resections. However, there does not appear to be greater long-term survival with larger volume resections despite greater improvement in spirometry. This study suggests that factors other than imp rovement in spirometric variables may govern optimal LVRS resection volumes and long-term outcome. Future studies will clearly be needed in this impor tant area of LVRS emphysema research. (C) 2000 by The Society of Thoracic S urgeons.