Lung volume reduction surgery

Lung volume reduction surgery, or LVRS, can improve the quality of life for certain COPD and emphysema patients. Parts of the lung that are particularly damaged by emphysema are removed, allowing the remaining, relatively good lung to expand and work better.

Conventional LVRS involves resection of the most severely affected areas of emphysematous, non-bullous lung (aim is for 20-30%). This is a surgical option involving a mini-thoracotomy for patients suffering end stage COPD due to underlying emphysema, and can improve lung elastic recoil as well as diaphragmatic function.

Increased mortality, contraindicating the procedure, is noted in patients that have both:

1. FEV₁ < 20%
2. DL_CO < 20% or diffusely distributed emphysema on a CT scan

The National Emphysema Treatment Trial (Fishman et al., 2003) was a large multicentre study (N = 1218) comparing LVRS with medical treatment. Results suggested that:

1. There was no overall survival advantage in the LVRS group, except for mainly upper-lobe emphysema + poor exercise capacity, and
2. Significant improvements were seen in exercise capacity in the LVRS group.

Possible complications (Hopkins et al., 2006):

• Mortality at 90 days of 1.8% and survival at 3 and 5 years of 91.1% and 76% respectively.
• Prolonged air leak (mean duration post surgery until all ICC's removed is 10.9 +/- 8.0 days)

References

• National Emphysema Treatment Trial Research Group; Alfred Fishman; Fernando Martinez; Keith Naunheim; Steven Piantadosi; Robert Wise; Andrew Ries; Gail Weinmann; Douglas E. Wood (2003-05-22). "A Randomized Trial Comparing Lung-Volume–Reduction Surgery with Medical Therapy for Severe Emphysema". New England Journal of Medicine (Boston: Massachusetts Medical Society) 348 (21): 2059–2073. doi:10.1056/NEJMoa030287. ISSN 0028-4793. OCLC 1587974. PMID 12759479. Retrieved 2009-07-13.
• Hopkins, P. M.; H. Seale; J. Walsh; R. Tam; F. Kermeen; S. Bell; K. McNeil (February 2006). "Long term results post conventional lung volume reduction surgery exceeds outcome of lung transplantation for emphysema". Journal of Heart and Lung Transplantation (St. Louis, Missouri: Mosby-Year Book) 25 (2): S61. doi:10.1016/j.healun.2005.11.053. ISSN 1053-2498. OCLC 22486861.