Lung Function 5 yr after Lung Volume Reduction Surgery for Emphysema

Abstract

Current datum more than 2 yr after lung volume reduction surgery (LVRS) for emphysema is limited. This prospective study evaluates pre-LVRS baseline and 5-yr results in 26 symptomatic patients (mean age 67 +/- 6 yr) (mean +/- SD) who underwent bilateral, targeted upper lobe stapled LVRS using video-assisted thoracoscopy. Baseline forced expiratory volume in 1 s (FEV(1)) was 0.7 +/- 0.2 L (mean +/- SD), 29 +/- 10% predicted. Following LVRS, with none lost to follow-up, mortality due to respiratory failure at 0.5, 1, 2, 3, 4, and 5 yr was 4%, 4%, 19%, 31%, 46%, and 58%, respectively. Increase above baseline for FEV(1) > 200 ml and/or FVC > 400 ml at 1, 2, 3, 4, and 5 yr post-LVRS was noted in 73%, 46%, 35%, 27%, and 8% of all patients; decrease in dyspnea grade >/= 1 in 88%, 69%, 46%, 27%, and 15%; and elimination of initial oxygen dependence in 18 patients in 78%, 50%, 33%, 22%, and 0%, respectively. Expiratory airflow improved due to the increase in both lung elastic recoil and small airway intraluminal caliber. Five patients decreased FEV(1) 141 +/- 60 ml/yr and FVC 102 +/- 189 ml/yr over 3.8 +/- 1.2 yr post-LVRS, similar to their pre-LVRS rate of decline. In the 11 patients who survived 5 yr, at 0.5-1.0 yr post-LVRS peak increase in FEV(1) was 438 +/- 366 ml, with a decline of 149 +/- 157 ml the following year and 78 +/- 59 ml/yr over 4.0-4.5 yr. Bilateral LVRS provided palliative clinical and physiological improvement in 9 of 26 patients at 3 yr, 7 at 4 yr, and 2 at 5 yr.

Effects of Lung Volume Reduction Surgery on Gas Exchange and Breathing Pattern During Maximum Exercise

“…26 Our present study extends these findings by showing that improved exercise following LVRS is due to the following improvements in ventilatory mechanics: less rapid and shallow breathing, reductions in ventilatory dead space, and enhanced carbon dioxide elimination. Approximately two thirds of our patients had ventilatory limitation as the primary etiology of early exercise termination.…”

“…19 -24 However, most of the published reports are uncontrolled, unicenter trials involving small numbers of patients with short-term follow-up. 3,5,[17][18][19]22,23,[25][26][27] The National Emphysema Treatment Trial (NETT) represents the most extensively characterized patient cohort with severe emphysema undergoing repeated exercise testing. Here we report the effects of optimal medical therapy plus LVRS vs optimal medical therapy alone on maximum exercise after outpatient rehabilitation and through 2 years postrandomization to treatment.…”

Lung volume reduction surgery: what can we learn from the National Emphysema Treatment Trial?: Fig. 1.—

“…Altogether, 608 patients were operated on at 17 centres, which gives an average of 36 interventions performed at each centre over a period of several years, most likely by several surgeons. This number is considerably lower than that reported by teams with larger case series [3,7,19].…”

Lung Volume Reduction Reoperations

“…However, due to the chronic and progressive nature of emphysema, postoperative improvements usually peak within the first 6 to 12 months and slowly decline subsequently, eventually returning back to the baseline status in many patients [5][6][7]. Optimal nonsurgical management of these patients is difficult owing to their poor clinical response to pharmacological therapy and is expensive because of the frequent need of outpatient or in-hospital care.…”