Lung volume reduction surgery: Results of a Canadian pilot study

OBJECTIVE: TO present preliminary experience with lung volume reduction sur gery (LVRS) before the institution of the Canadian LVRS trial. DESIGN: A prospective case series between December 1995 and January 1997. SETTING: University hospitals in London and Hamilton, Ont. PATIENTS: Forty-nine patients Who had disabling dyspnea or emphysema with h yperinflation, able to participate in respiratory rehabilitation. Twenty-th ree patients were excluded because of comorbid conditions precluding surger y, pulmonary hypertension, excessive steroid dependence, malnutrition, obes ity, previous thoracotomy, large solitary bullae, concurrent malignant dise ase, chronic bronchitis, hypercapnia or psychiatric illness. INTERVENTIONS: Preoperative respiratory rehabilitation followed by LVRS via median sternotomy. MAIN OUTCOME MEASURES: Impairment, disability and handicap were assessed be fore and 12 months after LVRS. Impairment was assessed by changes in pulmon ary function test results and blood gas measurements, disability by the 6-m inute walk test and cardiopulmonary exercise test, and handicap by the dise ase-specific chronic respiratory disease questionnaire (CRQ), the generic m edical outcomes survey short form 36 (SF-36) and the generic health utiliti es index mark III (HUI-III). RESULTS: TWO patients died of respiratory failure while in rehabilitation. Twenty-four patients (17 men, 7 women) successfully completed rehabilitatio n and underwent LVRS. The mean age was 63 years (range from 49 to 78 years) and the median length of hospital stay was 12.5 days (range from 7 to 90 d ays). Two patients (8%) died in the early postoperative period (within 30 d ays) of pneumonia. One patient died of respiratory failure 8 months after L VRS after a difficult 90-day postoperative hospital stay. There were 27 maj or complications. There was a 36% relative increase in the mean forced expi ratory volume in the first second (p = 0.01) and a 10% relative increase in the 6-minute walk test (P = 0.06). The mean CRQ dyspnea score increased 2. 3 points (p = 0.01), and the SF-36 general health domain increased 20 point s (p = 0.01). There was no significant change in the HUI-III (p = 0.73). CONCLUSION: LVRS appears to lessen the respiratory impairment and handicap for at least 1 year in selected patients with advanced emphysema.