Study objective: To evaluate the activity and evolution in the field of lun
g volume reduction surgery (LVRS) performed at surgical centers in Europe.
Background: LVRS is a novel surgical therapy, with the potential to inprove
lung function, exercise performance, and quality of life in selected patie
nts suffering from severe pulmonary emphysema.
Methods: Questionnaire addressed to 75 European thoracic surgical centers p
resumed to perform LVRS, and review of the literature.
Results: Of 35 responding centers, 42 centers in 17 countries covering a po
pulation of 423 million reported performing LVRS. Until the end of 1998, 1,
120 patients were reported to have undergone LVRS, corresponding to 2.6 pat
ients/million inhabitants. Thirty-one of 40 centers (78%) perform the opera
tion bilaterally. Most centers (83%) evaluate their activity prospectively.
The average perioperative mortality rate of 4.1% is moderate, The most com
monly utilized technique is video-assisted thoracoscopy, which is most freq
uently performed bilaterally. Two thirds of the centers treat patients with
alpha(1)-antitrypsin deficiency, and half of the centers will consider pat
ients with homogenous morphology of emphysema on CT scan for LVRS. Half of
the centers also perform lung transplantation. The five largest centers hav
e operated on 49% of all LVRS patients assessed by this survey.
Conclusions: LVRS is performed at few thoracic surgical centers throughout
Europe, with a large variation in the operative activity between different
regions, Half of the centers also perform lung transplantation. Between 199
5 and 1997, the number of LVRS procedures performed per year nearly tripled
but has reached a plateau since then, hs five centers perform nearly half
the total number of operations, an optimal exchange of knowledge with small
er centers seems important.