Lung Reduction Surgery in Emphysema

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Abstract
Recently, considerable enthusiasm has been generated by early reports that show significant subjective and objective functional improvement among patients with end-stage emphysema in whom lung volume reduction surgery is performed. Surgical reduction of the lungs can be achieved via sternotomy or by video-assisted thoracoscopic surgery, used to either resect a diseased lung with stapling devices or to shrink the bullous areas with laser therapy. Most investigators who use these techniques report an early increase in airflows, reduced residual volumes, and improved oxygenation, which in some patients will permit independence from oxygen therapy. These encouraging reports have to be cautiously weighed against the fact that there is important morbidity (prolonged air leak, secondary pneumonia, bleeding, respiratory failure) in a small percentage of patients. Mortality has been reported between 3% and 18%. Further clinical research is of critical importance to best define the profile of patients most likely to benefit from this surgery with the least possible risk. Similarly, further data must be available to define the long-term effects of volume reduction surgery.

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