Results of 150 consecutive bilateral lung volume reduction procedures in patients with severe emphysema

Abstract

Between January 1993 and February 1996, we performed 150 bilateral lung volume reduction procedures for patients with severe emphysema. Patients were selected on the basis of severe dyspnea, increased lung capacity, and a pattern of emphysema that included regions of severe destruction, hyperinflation, and poor perfusion. Twenty percent to 30% of the volume of each lung was excised with the use of a linear stapler and bovine pericardial strips attached to buttress the staple line. Patients were between 36 and 77 years old, with an average 1-second forced expiratory volume of 25% of predicted, total lung capacity of 142% of predicted, and residual volume of 283% of predicted. Ninety-three percent of patients required supplemental oxygen, continuously or with exertion. All patients but one were extubated at the end of the procedure. The 90-day mortality was 4%. Hospital stay progressively decreased with experience, and for the last 50 patients the median hospital stay was 7 days. Prolonged air leakage was the major complication. Results at 6 months show a 51% increase in the 1-second forced expiratory volume and a 28% reduction in the residual volume. The Pao2 increased by an average of 8 mm Hg, and 70% of the patients who had previously required continuous supplemental oxygen no longer had this requirement. The improvements in measured pulmonary function were paralleled by a significant reduction in dyspnea and an improvement in the quality of life. Reevaluation at 1 year and 2 years after operation showed the benefit to be well maintained. We conclude that lung volume reduction offers benefits not achievable by any means other than lung transplantation for highly selected patients with severe emphysema.

Nonpharmacological treatment and relief of symptoms in COPD: Table 1—

“…In centres with adequate experience, the perioperative mortality of LVRS has been reported to be ,5% for both median sternotomy and thoracoscopy [63].…”

Physiological basis of improvement after lung volume reduction surgery for severe emphysema: where are we?

“…Indeed, arterial oxygen tension (Pa,O 2 ) increased in all studies reporting this variable [4, 39, 41±45, 48, 50, 52±54, 56±58, 67, 68], although the improvement was only statistically significant in half of the studies [42,45,48,50,53,56,58,68]. Similarly, arterial carbon dioxide tension (Pa,CO 2 ) either showed a tendency to decrease [4,39,43,44,48,52,53,56,58] or a statistically significant decrease [41,42,45,54,57,67,68].…”

“…The distance walked always improved significantly after LVRS [39,40,42,43,48,49,51,54,56,59, 67±69]. Nevertheless, a majority of patients underwent pulmonary rehabilitation at least preoperatively and this clearly may have contributed to this improvement.…”

“…From the literature, it appears that the peak improvement in usual pulmonary function tests probably occurs between 3 and 12 months after surgery [43,45,58,59,66,95]. GELB et al [66] demonstrated that the subsequent deterioration of the functional test results was associated with a decrease in elastic recoil.…”

Redução de volume pulmonar - uma alternativa cirúrgica para o tratamento do enfisema pulmonar difuso grave?

“…Em torno do 6 o mês, 75% dos doentes operados que faziam uso contínuo não mais necessitam usar oxigênio. Os restantes 25% reduzem sua necessidade de O 2 ; doentes nos quais os campos superiores são os mais comprometidos são aqueles que melhores resultados apresentam após a cirurgia 27,30 ; os resultados indicam na direção de que a cirurgia deve ser bilateral e simultânea 32,33 . Em cirurgias unilaterais, o benefício funcional obtido com a redução do volume do pulmão operado é eliminado pelo crescimento compensatório do pulmão não operado contralateral.…”