Lung volume reduction surgery: an overview

Abstract

SUMMARYThis study intends to review the literature on the efficacy, safety and feasibility of lung volume reduction surgery (LVRS) in patients with advanced emphysema. Studies on LVRS from January 1995 to December 2009 were included by using Pubmed (MEDLINE) and Cochrane Library literature in English. Search words such as lung volume reduction surgery or lung reduction surgery, pneumoplasty or reduction pneumoplasty, COPD or chronic obstructive pulmonary disease and surgery, were used. We also compared medical therapy and surgical technique. Studies consisting of randomized controlled trials, controlled clinical trials (randomized and nonrandomized), reviews and case series were analyzed. Questions regarding validity of the early clinical reports, incomplete follow-up bias, selection criteria and survival, confounded the interpretation of clinical data on LVRS. Patients with upper, lower and diffuse distribution of emphysema were included; we also analyzed as key points perioperative morbidity and mortality and lung function measurement as FEV1. Bullous emphysema was excluded from this review. Surgical approach included median sternotomy, unilateral or bilateral thoracotomy, and videothoracoscopy with stapled or laser ablation. Results of prospective randomized trials between medical management and LVRS are essential before final assessment can be established.

Several clinical interests regarding lung volume reduction surgery for severe emphysema: meta-analysis and systematic review of randomized controlled trials

“…The shortness of breath, poor exercise tolerance and impaired health status will occur on the final stage of emphysema [1-3]. Thus far, the conservative medical therapies (antibiotics, bronchodilators, systemic corticosteroids, home oxygen therapy, pulmonary rehabilitation) still remain to be symptomatic treatment rather than always due to failure to improve elastic recoil of lung issue [2-5].…”

Lung volume reduction surgery in hypercapnic patients: a single-center experience from China

“…Chronic obstructive pulmonary disease (COPD) is a chronic and progressive airway inflammatory disease which is characterized by irreversible airflow limitation with shortness of breath, poor exercise tolerance and impaired health status on the final stage (1)(2)(3). Since 2012, COPD has been the third leading cause of death in the world, with nearly 3.1 million deaths per year, second only to ischemic heart disease and stroke patients.…”

Low cost biological lung volume reduction therapy for advanced emphysema

“…Because the principal defect in emphysema is hyperinflation due to destruction of elastic tissue, conventional medical treatment still remains to be symptomatic treatment and of limited value due to failure to improve elastic recoil of lung tissue. 1 …”