Outcomes after resection of giant emphysematous bullae

Abstract

Background: Giant emphysematous bullae represent a rare form of emphysematous lung destruction. Surgical resection has traditionally been indicated when there is hyperexpansion of the chest, compromised pulmonary function, and evidence of underlying, relatively normal compressed lung. We review our experience and intermediate-term follow-up after the resection of giant bullae.

Methods: Forty-three patients underwent resection of giant emphysematous bullae at Barnes-Jewish Hospital between March 1994 and June 2002. All had limiting dyspnea and radiologic evidence of hyperinflated giant bullae compressing adjacent lung parenchyma. Forty-one patients underwent preoperative pulmonary rehabilitation. Twenty-two patients underwent a bilateral procedure and 21 underwent a unilateral procedure. Mean follow-up was 4.5 years.

Results: One early death occurred on postoperative day 20 from heparin-induced thrombocytopenia and pulmonary embolism. Complications included prolonged air leak of more than 7 days in 23 (53%), atrial fibrillation in 5 (12%), postoperative mechanical ventilation in 4 (9%), and pneumonia in 2 (5%). Kaplan-Meier survival at 1, 3, and 5 years was 98%, 92%, and 89%, respectively. Four late deaths occurred at 1.4, 2.8, 3.5, and 5.9 years. Functional measures preoperatively and at 6 months and 3 years postoperatively were a forced expiratory volume in 1 second L (% predicted) of 1.2 +/- 0.6 (34%), 1.9 +/- 0.9 (55%), and 1.5 +/- 0.8 (49%); residual volume L (% predicted) of 5.1 +/- 1.2 (262%), 3.6 +/- 1.2 (154%), and 4.1 +/- 2.2 (209%); 6-minutes walk (ft) of 1230 +/- 361, 1393 +/- 300, and 1271 +/- 423; supplemental O2 used continuously (% patients) of 42%, 9%, and 21%; and O2 used during exercise of 73%, 37%, and 42%, respectively.

Conclusions: In a contemporary series, giant bullectomy is shown to produce significant immediate functional improvement. This benefit declines with time but persists at least 3 years.