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.