Lung volume reduction surgery for emphysema

Abstract

Lung volume reduction surgery (LVRS) is performed to alleviate dyspnoea of selected patients with severe pulmonary emphysema and to improve their pulmonary function, performance in daily activity and quality of life. By resection of destroyed lung areas the achievable improvements in function may consist of: 1) a reduction in hyperinflation resulting in amelioration of diaphragm and chest wall mechanics; 2) an increase of elastic recoil pressure, thereby augmenting expiratory flow rates; and 3) possibly an improvement in gas exchange. Meticulous selection of suitable patients, refinements in operative techniques, anaesthesiological and postoperative management has lowered perioperative mortality to less than 5% in groups who are experienced with this type of procedure. The best functional results are achieved by bilateral resection, which can either be performed by median sternotomy or by video-assisted thoracoscopy (VAT). The average increase in forced expiratory volume in one second (FEV1), obtained by bilateral resection in patients already receiving optimal medical therapy ranges 32-93%, and the reduction in hyperinflation, assessed by a decrease in total lung capacity ranges 15-20%. These favourable improvements have been reported to last in most of the patients for at least one year.