Lung volume reduction surgery for the treatment of severe emphysema: A study in a single Canadian institution

OBJECTIVE: To evaluate lung Volume reduction surgery (LVRS) and its effecti veness in improving pulmonary function, exercise capacity and quality of li fe in a population of emphysema patients referred to and screened in a sing le centre. DESIGN: A Prospective case series. SETTING: A Canadian tertiary care hospital. PATIENTS: Patients with severe emphysema, significant dyspnea and impaired exercise capacity interfering with quality of life. INTERVENTIONS: Bilateral LVRS was performed through a median sternotomy. MAIN OUTCOME MEASURES: Pulmonary function tests (preoperative forced expira tory volume in the first second [FEV1], residual volume [RV]), 6-minute wal k (6MW) distance, quality of life (Medical Outcomes Study 36-item short-for m health survey) and degree of dyspnea (Medical Research Council of Great B ritain dyspnea scale and the baseline and transitional dyspnea indices) wer e assessed before LVRS and at 6 and 12 months after. RESULTS: Fifty-seven patients were assessed for LVRS, of whom 10 were selec ted for surgery. Homogeneous distribution of disease was the most common re ason for exclusion. Of the 10 patients operated upon, 1 died of acute cor p ulmonale on the fourth postoperative day and 1 died of recurrent exacerbati ons of chronic obstructive pulmonary disease and chronic respiratory failur e at 315 days postoperatively. In the surviving patients, the mean preopera tive FEV, increased from 0.70 L before surgery to 0.90 L at 1 year, with a mean relative increase of 33.4%. The mean RV decreased from 5.57 L to 4.10 L, with a mean relative decrease of 27.6%. The 6MW distance increased from 302.7 m to 356.9 m at 1 year, with a mean relative increase of 21.6%. Quali ty of life and degree of dyspnea were improved significantly at 1 year afte r LVRS. Of the 5 patients on oxygen at home before surgery, 4 were able to reduce their requirements but not to discontinue oxygen. CONCLUSIONS: LVRS is an effective palliative treatment fur dyspnea and poor exercise tolerance in highly selected patients. Although the duration of p alliation is unknown, our results show that improvements in pulmonary funct ion, exercise, quality of life and degree of dyspnea are preserved over the : first year. Only a minority of the patients screened were eligible for su rgery. The 2 deaths in our series emphasize the need for even further delin eation of selection criteria.