Short-term and long-term outcomes after bilateral lung volume reduction surgery - Prediction by quantitative CT

Objectives: To evaluate selection criteria and duration of benefit for pati ents undergoing lung volume reduction surgery (LVRS). Methods: Eighty-nine consecutive patients with severe emphysema who underwe nt bilateral LVRS were prospectively followed up for up to 3 years. Patient s underwent preoperative pulmonary function testing, 6-min walk, chest CT, and answered a baseline dyspnea questionnaire. CT scans in 65 patients were analyzed for emphysema extent and distribution using the percentage of emp hysema in the lung, percentage of normal lower lung, and the CT emphysema r atio (CTR, an index of the craniocaudal distribution of emphysema). All pat ients underwent at least 6 weeks of pulmonary rehabilitation prior to surge ry Outcome measures were FEV1, 6-min walk distance, and transitional dyspne a index (TDI), Results: Compared to baseline, FEV, was significantly increased at 3, 6, 12 , 18, 24, and 36 months after surgery (p less than or equal to 0.008). The 6-min walk distance increased from 871 feet (baseline) to 1,110 feet (3 mon ths), 1,214 feet (6 months), 1,326 feet (12 months), 1,342 feet (18 months) , 1,371 feet (24 months), and 1,390 feet (36 months) after surgery. Despite a decline in FEV, over time, B-min walk distance was preserved. Dyspnea as measured by TDI improved at 3, 6, 12, 18, 24, and 36 months after surgery. A high CTR was the best predictor of a 12% increase over baseline and an a bsolute increase of 200 mt in FEV,, although with a lo,v area under the rec eiver operating characteristic curve. In addition, the sensitivity and nega tive predictive value of the CTR were limited. No radiographic or physiolog ic predictor was able to consistently predict a successful increase in walk distance or TDI, Conclusion: LVRS improves pulmonary function, decreases dyspnea, and enhanc es exercise capacity in many patients with severe emphysema, although impro vement wanes 36 months after surgery.