Surgery for Emphysema

Knudson, Ronald J.; Gaensler, Edward A.

doi:10.1016/s0003-4975(10)66764-1

Cited by 56 publications

(12 citation statements)

References 99 publications

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“…Bullae have been known to be associated with airway obstruction (10)(11)(12)(13)(14) but it has never been clearly demonstrated whether they cause or contribute to the obstruction, whether the obstruction produces the bullae, or whether there is a generalized disease that produces both the bullae and the airway obstruction. Although the spirometric studies in most of our patients (Table II) On the basis of our findings, we see no reason to change the criteria for surgery outlined by Baldwin et al (12) and further elaborated by Laurenzi, Turino, and Fishman (10).…”

Section: Effect Of Removal Of Bullae On Airway Conductancementioning

confidence: 99%

Effect of removal of bullae on airway conductance and conductance volume ratios

Rogers¹,

DuBois²,

Blakemore³

1968

J. Clin. Invest.

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Section: Effect Of Removal Of Bullae On Airway Conductancementioning

confidence: 99%

Effect of removal of bullae on airway conductance and conductance volume ratios

Rogers¹,

DuBois²,

Blakemore³

1968

J. Clin. Invest.

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“…1 Initial attempts were fraught with significant operative mortality and failure to objectively demonstrate improved pulmonary function. 2 As a r esult, medical therapy persisted as the primary form of treatment for COPD . ment in surgical technique, improve ment in preoperative evaluation and postoperative critical care, and enhance ment of pulmonary function analysis have permitted LVRS to re-e merge as a truly viable alternative in the manage ment of s elect patients v.rith chronic, debilitating, emphysematous lung disease.…”

mentioning

confidence: 99%

Pathologic Findings in Lung Volume Reduction Surgery

Duarte¹,

Gal

Mansour³

et al. 1998

Chest

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“…In the 1950s,exploratory work described surgical lung-volume-reduction procedures for the treatment of patients with emphysema (1)(2)(3). Interest in surgical approaches waned because of marginal acute and long-term successof the initial procedures (1).…”

mentioning

confidence: 99%

Objective predictors of response for staple versus laser emphysematous lung reduction.

Brenner

McKenna²,

Gelb³

et al. 1997

Am J Respir Crit Care Med

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Recently described surgical approaches to the treatment of emphysema, including buttressed stapled volume reduction and laser coagulation, are associated with variable clinical outcomes. We examined objective preoperative factors as predictors of response to treatment in patients enrolled in a randomized trial of staple versus laser volume-reduction surgery in order to help define patient selection criteria for these procedures. Seventy-two patients with severe symptomatic emphysema without bullae were entered into the protocol (39 staple, 33 laser). Preoperative objective variables (pulmonary function tests, smoking history, demographics, and graded chest computed tomographic [eT] scans) were evaluated as predictors of response to treatment (defined as a change in FEV1) at 3-to 6-mo follow-up, using linear and multivariate regression analysis. Follow-up pulmonary function was obtained on 90% of the 68 patients surviving at 6 mo. Overall improvement was significant only for staple-treated patients, and improved outcome correlated with greater smoking history and younger age for stapletreated patients. When physiologic variables were analyzed, greater smoking history, lower Dl..co, and younger age predicted improved outcome for laser-treated patients. Preoperative FEV1 and gasexchange variables did not predict outcome in staple-treated patients. When CTscan grading was included in multivariate regression analysis, hyperinflation (increased thoracic gas volume) was the primary predictor of response for laser-treated patients. These findings suggest that younger patients with evidence of advanced emphysematous lung disease and hyperinflation are optimal candidates for lung-volume-reduction surgery, particularly by staple-reduction techniques. Additional studies with long-term follow-up, bilateral procedures, and assessment of other outcome measures must be performed to further define operative criteria for lung-volume-reduction surgery for emphysema. Brenner M, McKenna R, Jr., Gelb A, Osann K, Schein MJ, Panzera J, Wong H, Bems MW, Wilson AF. ObJedlve preclldon of response for staple venus laser emphysematous lung redudlon.

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Surgery for Emphysema

Cited by 56 publications

References 99 publications

Effect of removal of bullae on airway conductance and conductance volume ratios

Effect of removal of bullae on airway conductance and conductance volume ratios

Pathologic Findings in Lung Volume Reduction Surgery

Objective predictors of response for staple versus laser emphysematous lung reduction.

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