Comparison of clinical results for unilateral and bilateral thoracoscopic lung volume reduction

Background. It is widely believed that bilateral thoracoscopic lung volume reduction (BTLVR) yields superior results when compared with unilateral tho racoscopic lung volume reduction (UTLVR) with regard to spirometry, functio nal capacity, oxygenation and quality of life results. Methods. To address these issues, we compared the results of patients under going UTLVR (N = 338 patients) and BTLVR (N = 344 patients) from 1993 to 19 98 at five institutions. Follow-up data were available on 671 patients (98. 4%) between 6 and 12 months after surgery, and a patient self-assessment wa s obtained at a mean of 24 months. Results. It was found that BTLVR provides superior improvement in measured postoperative percent change in FEV1 (L) (UTLVR 23.3% +/- 55.3 vs BTLVR 33% +/- 41, p = 0.04), FVC(L) (10.5% +/- 31.6 vs 20.3% +/- 34.3, p = 0.002)and RV(L) (-13% +/- -22 vs -22% +/- 17.9, p = 0.015). BTLVR also provides a sl ight improvement over UTLVR in patient's perception regarding improved qual ity of life (UTLVR 79% vs BTLVR 88%, p = 0.03) and dyspnea relief (71% vs 6 1%, p = 0.03). There was no difference in mean changes in Po, (mm Hg) (UTLV 4.5 +/- 12.3 vs BTLVR 4.9 +/- 13.3, p = NS), 6-minute walk (UTLVR 26% +/- 66.1 vs BTLVR 31% +/- 59.6, p = NS) or decreased oxygen utilization (UTLVR 78% vs BTLVR 74%, p = NS). Conclusions. These data suggest that both UTLVR and BTLVR yield significant improvement, but the results of BTLVR seem to be superior with regard to s pirometry, lung volumes, and quality of life. (C) 2000 by The Society of Th oracic Surgeons.