Lung volume reduction surgery: Lessons learned

Miller, Joseph I.; Lee, Robert B.; Mansour, Kamal A.

doi:10.1016/0003-4975(96)00124-5

Cited by 122 publications

(71 citation statements)

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“…Miller and cols. 26 published a recent study comparing LVRS to optimal medical therapy in two clinical trials and concluded that in carefully selected patients with advanced heterogeneous emphysema, quality of life had improved 6 to 12 months after LVRS combined with optimal medical therapy, results superior to those of patients who received optimal medical therapy only. Fishman and cols.…”

Section: Discussionmentioning

confidence: 99%

Lung volume reduction surgery: an overview

Sardenberg¹,

Younes

Deheizelin

2010

Rev. Assoc. Med. Bras.

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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.

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Section: Discussionmentioning

confidence: 99%

Lung volume reduction surgery: an overview

Sardenberg¹,

Younes

Deheizelin

2010

Rev. Assoc. Med. Bras.

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“…Besides FEV1, more specific indices of airflow obstruction have been reported less frequently. Three groups reported improved FEV1/VC ratios, using stapling techniques and with most patients operated on bilaterally [52,61,62]. Others found a lack of significant improvement in FEV1/VC [4,48,53,59].…”

Section: Pathophysiological Basis Of Functional Impairment In Emphysemamentioning

confidence: 98%

“…Indeed, arterial oxygen tension (Pa,O 2 ) increased in all studies reporting this variable [4, 39, 41±45, 48, 50, 52±54, 56±58, 67, 68], although the improvement was only statistically significant in half of the studies [42,45,48,50,53,56,58,68]. Similarly, arterial carbon dioxide tension (Pa,CO 2 ) either showed a tendency to decrease [4,39,43,44,48,52,53,56,58] or a statistically significant decrease [41,42,45,54,57,67,68].…”

Section: Pathophysiological Basis Of Functional Impairment In Emphysemamentioning

confidence: 99%

“…In contrast to rehabilitation, which essentially lowers the ventilatory requirement but does not affect maximal ventilation, LVRS has been shown to increase the maximal ventilatory capacity. Indeed, both maximal voluntary ventilation (MVV) [41,48,51,52,59] and maximal minute ventilation (V 'E,max) at peak exercise [41,42,48,59,61] significantly increased after LVRS. This increase in V 'E,max was entirely due to an increase in tidal volume, since the respiratory rate did not change [41,48,51,59,61].…”

Section: Breathing During Exercisementioning

confidence: 99%

“…This should not obscure the fact that up to 20% of the patients do not experience an improvement either subjectively or in the pulmonary function tests [4, 39, 41, 42, 45±48, 51, 52, 54, 57, 61, 62] and that mortality is not negligible [4,39,40,43,47,49,50,52,54,58,99], reaching 10% in some series [49]. The determinants of outcome have not yet received much attention.…”

Section: Future Prospectsmentioning

confidence: 99%

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Physiological basis of improvement after lung volume reduction surgery for severe emphysema: where are we?

Marchand¹,

Gayan‐Ramirez²,

Leyn³

et al. 1999

Eur Respir J

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Physiological basis of improvement after lung volume reduction surgery for severe emphysema: where are we? E. Marchand, G. Gayan-Ramirez, P. De Leyn, M. Decramer. #ERJ Journals Ltd 1999. ABSTRACT: Lung volume reduction surgery has become an accepted therapeutic option to relieve the symptoms of selected patients with severe emphysema. In a majority of these patients, it causes objective as well as subjective functional improvement. A proper understanding of the physiological determinants underlying these beneficial effects appears very important in order to better select patients for the procedure that is currently largely carried out on an empirical basis.Lung volume reduction surgery has two distinct effects. Firstly, it causes an increased elastic recoil, which at least partially explains the enhanced maximal expiratory flow. Secondly, it is associated with a reduction of hyperinflation which allows for an increase in global inspiratory muscle strength and in diaphragmatic contribution to tidal volume as well as a decrease in the inspiratory elastic load imposed by the chest wall. Taken together, these effects result in a reduced work of breathing and in an enhanced maximal ventilation which both contribute to the increased exercise capacity and reduced dyspnoea after surgery. The improved lung recoil and the reduced hyperinflation after volume reduction surgery were the primary postulates upon which the usual selection criteria for the procedure were based. It is now likely that these are correct. Nevertheless, some patients do not benefit from lung volume reduction surgery and the current literature does not allow for a refinement of the selection process from a physiological point of view.The exact mechanisms underlying the improvement in lung recoil, lung mechanics, and respiratory muscle function remain incompletely understood. Moreover, the effects of lung volume reduction surgery on gas exchange and pulmonary haemodynamics still need to be more fully investigated. An analysis of the characteristics of patients who do not benefit from the procedure and the development of an animal model for lung volume reduction surgery would probably help address these important issues. Eur Respir J 1999; 13: 686±696.

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