Lung volume reduction surgery for emphysema

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Abstract
Objective To report the results of lung volume reduction surgery (LVRS) for severe emphysema in Australia. Setting A tertiary teaching hospital. Design A prospective study of a consecutive case series. Participants 20 patients (mean age, 56 years) with severe emphysema‐ mean forced expiratory volume in one second (FEV1), 0.72 L (28% of predicted) and severe gas trapping (mean residual volume, 286% of predicted). Intervention Bilateral apical LVRS was performed via a median sternotomy with a linear stapler; bovine pericardia! strips were used to reinforce the staple line. Results There was a 95% survival, and a mean (range) inpatient stay of 17 (8‐45) days. No complications occurred in nine patients; a further six patients had only minor complications. Five patients had major complications (sputum retention requiring reintubation, persistent air leak requiring reoperation, duodenal perforation, and epidural haemorrhage); one patient died from multiorgan failure at 28 days. Intercostal drainage was left in situ for a mean of eight days. The results of FEV1, Medical Research Council (MAC) Dyspnoea Score and six‐minute walk test improved in more than 90% of patients. FEV1 improved an average of 0.35 L (54% over baseline) (P<0.001 ). Mean MAC Dyspnoea Score decreased from 3.4 to 2.1 (P<0.001 ). Mean distance for the six‐minute walk test increased from 306 to 431 metres (P<0.001). Conclusion Our experience confirms that LVRS produces worthwhile early outcomes for a subgroup of patients with severe emphysema. The clinical, economic and ethical questions raised by this new therapy will need to be assessed.

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