THORACOSCOPIC BILATERAL LUNG-VOLUME REDUCTION FOR DIFFUSE PULMONARY-EMPHYSEMA

Objective: In a prospective study, we investigated the functional resu lts, complications and survival of bilateral video-assisted thoracosco pic (VAT) lung volume reduction (LVR) in a selected group of patients with severe, nonbullous pulmonary emphysema. From January 1994 to Sept ember 1996, 42 of 143 candidates (13 female, 29 male: 42-78 years) wer e operated. They were short of breath on minimal exertion due to sever e airflow obstruction and hyperinflation (FEV1 < 30% pred., TLC > 130% pred., RV > 200% pred.). Methods: LVR was performed bilaterally by VA T using endoscopic staplers without buttressing the staple lines. Pulm onary function test (PFT), MRC dyspnea score and 12 min walking distan ce were assessed preoperatively, at 3, 6 and 12 months. In addition lu ng function was measured at hospital discharge. Results: The patients reported a marked relief of dyspnea, which persisted at all follow-up visits (P < 0.001). FEV1 increased from 0.80 +/- 0.24 (L) to 1.14 +/- 0.41 (L) postoperatively, a 43% gain (P < 0.001). A relevant increase of FEV1 persisted for at least 1 year. The residual volume to total lu ng capacity ratio decreased from 0.64 to 0.56 at hospital discharge. T he mean 12 min walking distance increased from 500 +/- 195 (m) to 770 +/- 222 (m) after 1 year (P < 0.001). The mean hospital stay was 13 +/ - 5.5 days (median 12.0), drainage time was 9 +/- 4.3 (median 8.0) day s. There was no 30 day mortality. Three patients died between 2 and 15 months postoperatively by non surgery related reasons. One patient un derwent lung transplantation 5 months after surgical lung volume reduc tion. Conclusions: In a selected group of patients with severe, nonbul lous pulmonary emphysema, bilateral LVR by VAT results in instantaneou s postoperative improvement in pulmonary function and dyspnea. These f avorable effects, including an amelioriation in exercise performance, lasted for at least 1 year. (C) 1997 Elsevier Science B.V.