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Van Dijk M, Van De Wauwer C, Koster TD, Klooster K, Slebos DJ. Lung volume reduction surgery is safe and feasible after initial endobronchial valve treatment for emphysema patients. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae094. [PMID: 38724230 PMCID: PMC11127104 DOI: 10.1093/icvts/ivae094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/11/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVES Bronchoscopic lung volume reduction with endobronchial valves is a guideline treatment leading to improved pulmonary function, exercise tolerance and quality of life, in patients with advanced emphysema, severe hyperinflation and no collateral ventilation. After valve treatment, loss of the initial lung volume reduction effect can occur, as well as local valve-induced complications such as persistent haemoptysis. In these cases, a surgical lobectomy can be considered to achieve similar efficacy outcomes. We evaluated the safety and feasibility of a video-assisted thoracoscopic surgery lobectomy after valve treatment. METHODS This single-centre retrospective study included patients who underwent an elective lobectomy after previous valve treatment. Data were evaluated for safety and efficacy for the additional surgical procedure. RESULTS Twenty-one patients [73% female, median age 67 (7) years, forced expiratory volume in 1 s 29 (7) %pred, and residual volume 223 (58) %pred] were included. There was no 90-day mortality and there were no postoperative intensive care admissions. Pulmonary infections (14%) and prolonged air leak (14%) were the most common complications. In patients who underwent surgery due to loss or lack of effect of valve treatment, a lobectomy led to a significant improvement in pulmonary function; median forced expiratory volume in 1 s +75 (193) ml (P < 0.013), forced vital capacity +450 (572) ml (P = 0.001), residual volume -665 (715) ml (P = 0.005). In patients who underwent a lobectomy because of complications of valve treatment, all complications were resolved after surgery. CONCLUSIONS We demonstrate that an elective lobectomy after an initial valve treatment is safe and feasible and restores the lung volume reduction effect.
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Affiliation(s)
- Marlies Van Dijk
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningenv, Groningen, Netherlands
- Groningen Research Institute for Asthma and COPD, Groningen, Netherlands
| | - Caroline Van De Wauwer
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - T David Koster
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningenv, Groningen, Netherlands
- Groningen Research Institute for Asthma and COPD, Groningen, Netherlands
| | - Karin Klooster
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningenv, Groningen, Netherlands
- Groningen Research Institute for Asthma and COPD, Groningen, Netherlands
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningenv, Groningen, Netherlands
- Groningen Research Institute for Asthma and COPD, Groningen, Netherlands
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Magarinos J, Egelko A, Criner GJ, Abbas A, Enofe N, Thomas J, Carney K, Friedberg J, Bakhos C. Lung volume reduction surgery is safe and leads to functional improvement in patients who fail or cannot undergo bronchoscopic lung volume reduction. JTCVS OPEN 2024; 18:369-375. [PMID: 38690414 PMCID: PMC11056479 DOI: 10.1016/j.xjon.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 05/02/2024]
Abstract
Background Bronchoscopic lung volume reduction (BLVR) has supplanted surgery in the treatment of patients with advanced emphysema, but not all patients qualify for it. Our study aimed to investigate the outcomes of lung volume reduction surgery (LVRS) among patients who either failed BLVR or were not candidates for it. Methods We conducted a retrospective analysis of patients who underwent LVRS for upper lobe-predominant emphysema at a single tertiary center between March 2018 and December 2022. The main outcomes measures were preoperative and postoperative respiratory parameters, perioperative morbidity, and mortality. Results A total of 67 LVRS recipients were evaluated, including 10 who had failed prior valve placement. The median patient age was 69 years, and 35 (52%) were male. All procedures were performed thoracoscopically, with 36 patients (53.7%) undergoing bilateral LVRS. The median hospital length of stay was 7 days (interquartile range, 6-11 days). Prolonged air leak (>7 days) occurred in 20 patients. There was one 90-day mortality from a nosocomial pneumonia (non-COVID-related) and no further deaths at 12 months. There were mean improvements of 10.07% in forced expiratory volume in 1 second and 4.74% in diffusing capacity of the lung for carbon monoxide, along with a mean decrease 49.2% in residual volume (P < .001 for all). The modified Medical Research Council dyspnea scale was improved by 1.84 points (P < .001). Conclusions LVRS can be performed safely in patients who are not candidates for BLVR and those who fail BLVR and leads to significant functional improvement. Long-term follow-up is necessary to ensure the sustainability of LVRS benefits in this patient population.
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Affiliation(s)
- Jessica Magarinos
- Department of General Surgery, Temple University Hospital, Philadelphia, Pa
| | - Aron Egelko
- Department of General Surgery, Temple University Hospital, Philadelphia, Pa
| | - Gerard J. Criner
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pa
| | - Abbas Abbas
- Lifespan Health System, Department of Thoracic Oncology, Brown University, Providence, RI
| | - Nosayaba Enofe
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pa
| | - JiJi Thomas
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pa
| | - Kevin Carney
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pa
| | - Joseph Friedberg
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pa
| | - Charles Bakhos
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pa
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Caviezel C, Steinack C, Schneiter D, Gaisl T, Schmitt-Opitz I. [Surgical or bronchoscopic lung volume reduction for emphysema therapy]. Zentralbl Chir 2023; 148:S51-S70. [PMID: 37604145 DOI: 10.1055/a-1990-4810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
More than 20 years ago, surgical lung volume reduction (LVRS) was already established in patients with advanced emphysema as a palliative therapy option that reduces respiratory distress and improves lung function and quality of life. In addition, bronchoscopic procedures (BLVR) aimed at volume reduction have existed for just over 10 years. The advantages and disadvantages of LVRS and BLVR are discussed in this article.
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Brock JM, Schuster PU, Böhmker F, Eberhardt R, Gompelmann D, Kontogianni K, Trudzinski F, Benjamin N, Herth F. Endobronchial Valve Replacements in Patients with Advanced Emphysema After Endoscopic Lung Volume Reduction. Int J Chron Obstruct Pulmon Dis 2023; 18:933-943. [PMID: 37229440 PMCID: PMC10204716 DOI: 10.2147/copd.s408674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/30/2023] [Indexed: 05/27/2023] Open
Abstract
Purpose Up to 41% of patients with endobronchial valve implantation need revision bronchoscopies and valve replacements most likely due to valve dysfunction or lack of benefit. So far, no data is available whether valve replacements lead to the desired lobar volume reduction and therapy benefit. Patients and Methods We conducted a single-center retrospective analysis of patients with endobronchial valve implantation and at least one valve replacement. Indications and number of revision bronchoscopies and valve replacements were evaluated. Therapy benefit regarding lung function and exercise capacity as well as development of complete lobar atelectasis was investigated and possible predictors identified. Results We identified 73 patients with 1-12 revision bronchoscopies and 1-5 valve replacements. The main indication for revision bronchoscopy in this group was lack of therapy benefit (44.2%). Lung function and exercise capacity showed improvements in about one-third of patients even years after the initial implantation. A total of 26% of all patients showed a complete lobar atelectasis at the end of the observation period, 56.2% had developed lung volume reduction. The logistic regression revealed the development of a previous complete lobar atelectasis as predictor for a complete lobar atelectasis at final follow-up. Oral cortisone long-term therapy was also shown as predictive factor. The probability for a final complete lobar atelectasis was 69.2% if a lobar atelectasis had developed before. Conclusion Valve replacements are more likely to be beneficial in patients who develop a re-aeration of a previous lobar atelectasis following valve implantation. Every decision for revision bronchoscopy must be taken carefully.
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Affiliation(s)
- Judith Maria Brock
- Department of Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | | | - Felix Böhmker
- Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Ralf Eberhardt
- Department of Pneumology and Intensive Care Medicine, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Daniela Gompelmann
- Department of Internal Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Konstantina Kontogianni
- Department of Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Franziska Trudzinski
- Department of Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Nicola Benjamin
- Department of Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Felix Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
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Koster TD, Dijk MV, Slebos DJ. Bronchoscopic Lung Volume Reduction for Emphysema: Review and Update. Semin Respir Crit Care Med 2022; 43:541-551. [PMID: 35562097 DOI: 10.1055/s-0042-1747938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In carefully selected patients with severe chronic obstructive pulmonary disease, characterized by emphysema and hyperinflation, lung volume reduction is an option to reduce lung hyperinflation, improve lung function, quality of life, and exercise capacity. Currently, there are several bronchoscopic and surgical treatment options to achieve lung volume reduction. It is important to carefully phenotype these patients, to select the optimal treatment option, with consideration of possible adverse events or contraindications, and it is highly recommended to discuss these treatment strategies in a multidisciplinary team. The treatment with one-way endobronchial valves has been investigated most extensively and more data are available regarding the treatment of more "marginal cases," or subsequent lung volume reduction surgery. Other bronchoscopic lung volume reduction options include treatment with coils, thermal vapor ablation, and sclerosant agents. In this review, we aim to summarize the current clinical evidence on the bronchoscopic lung volume reduction therapies and important aspects regarding optimal patient selection.
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Affiliation(s)
- T David Koster
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marlies Van Dijk
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Robotic lung volume reduction surgery with extracorporeal membrane oxygenation. Ann Thorac Surg 2022; 114:e351-e354. [PMID: 35216991 DOI: 10.1016/j.athoracsur.2022.01.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/14/2022] [Accepted: 01/21/2022] [Indexed: 11/23/2022]
Abstract
Lobectomy for consolidation of failed endoscopic lung volume reduction for emphysema has been reported in selected patients with favorable results but with considerable morbidity. The challenging issues in such patients are frailty caused by severe emphysema itself, poor tolerance to single lung ventilation, target lobe hyperinflation, and inability to use gas inflation for the minimally invasive resection. Careful planning, including using a robotic platform and ECMO support, can circumvent such difficulties and ensure a safe minimally invasive resection in the high-risk emphysematous patient.
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Hartman JE, Slebos DJ. Lung volume reduction in real clinical practice. ERJ Open Res 2021; 7:00258-2021. [PMID: 34109245 PMCID: PMC8181805 DOI: 10.1183/23120541.00258-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 11/05/2022] Open
Abstract
Pragmatic studies and capturing routine care clinical data in registration databases are important to further guide and optimise treatments in the future https://bit.ly/3el1lh7.
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Affiliation(s)
- Jorine E Hartman
- Dept of Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Dirk-Jan Slebos
- Dept of Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Dooms C, Blondeel A, Ceulemans LJ, Coolen J, Everaerts S, Demeyer H, Troosters T, Verleden G, Van Raemdonck D, Janssens W. Lung volume reduction in emphysema: a pragmatic prospective cohort study. ERJ Open Res 2021; 7:00877-2020. [PMID: 34084783 PMCID: PMC8165372 DOI: 10.1183/23120541.00877-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/19/2021] [Indexed: 11/05/2022] Open
Abstract
Limited guidance exists for the implementation of lung volume reduction interventions in routine clinical care. We designed a pragmatic study to evaluate a strategy including endoscopic lung volume reduction (ELVR) and lung volume reduction surgery (LVRS) in heterogeneous emphysema. This prospective monocentre cohort study evaluated ELVR versus no-ELVR, followed by a cohort study evaluating LVRS. Primary outcome was the proportion of subjects with a forced expiratory volume in 1 s (FEV1) improvement of ⩾100 mL at 3-month follow-up. Changes in FEV1, residual volume (RV), 6-min walk distance (6MWD) and quality of life (St George's Respiratory Questionnaire (SGRQ)) were evaluated at 6-month follow-up. Hospital stay and treatment-related serious adverse events were monitored. From 106 subjects screened, 38 subjects were enrolled comparing ELVR (n=20) with no-ELVR (n=18). After 6 months' follow-up, eligible patients were referred for LVRS (n=16) with another 6-month follow-up. At 3-month follow-up, 70% of ELVR compared to 11% of no-ELVR (p<0.001) and 69% of LVRS had an FEV1 improvement of ⩾100 mL. Between-group differences (mean±sem) for ELVR versus no-ELVR at 6-month follow-up were FEV1 +0.21±0.05 L; RV -0.95±0.21 L; 6MWD 58±17 m and SGRQ -18±5 points. At 6-month follow-up, within-group differences (mean±sem) for LVRS showed FEV1 +0.27±0.06 L; RV -1.49±0.22 L and 6MWD +75±18 m. Serious adverse events in 81% versus 45% of subjects (p=0.04) and a median hospital stay of 15 versus 5 days (p<0.001) were observed for LVRS versus ELVR, respectively. This pragmatic prospective cohort study supports a clinical approach with ELVR as a less invasive first option and LVRS as powerful alternative in severe heterogeneous emphysema.
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Affiliation(s)
- Christophe Dooms
- Clinical Dept of Respiratory Diseases, University Hospitals Leuven, BREATHE, Dept CHROMETA, KU Leuven, Leuven, Belgium.,These authors contributed equally
| | - Astrid Blondeel
- Dept of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,These authors contributed equally
| | - Laurens J Ceulemans
- Clinical Dept of Thoracic Surgery, University Hospitals Leuven, BREATHE, Dept CHROMETA, KU Leuven, Leuven, Belgium
| | - Johan Coolen
- Clinical Dept of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Stephanie Everaerts
- Clinical Dept of Respiratory Diseases, University Hospitals Leuven, BREATHE, Dept CHROMETA, KU Leuven, Leuven, Belgium
| | - Heleen Demeyer
- Dept of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Dept of Rehabilitation Sciences, Ghent University, Leuven, Belgium
| | | | - Geert Verleden
- Clinical Dept of Respiratory Diseases, University Hospitals Leuven, BREATHE, Dept CHROMETA, KU Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Clinical Dept of Thoracic Surgery, University Hospitals Leuven, BREATHE, Dept CHROMETA, KU Leuven, Leuven, Belgium
| | - Wim Janssens
- Clinical Dept of Respiratory Diseases, University Hospitals Leuven, BREATHE, Dept CHROMETA, KU Leuven, Leuven, Belgium
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Valdivia D, Langehegermann L, Aigner C. Lobectomy as lung volume reduction surgery in a patient with previous contralateral bilobectomy. Ann Thorac Surg 2021; 112:e261-e264. [PMID: 33529606 DOI: 10.1016/j.athoracsur.2021.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/06/2021] [Accepted: 01/16/2021] [Indexed: 11/26/2022]
Abstract
Lung-volume-reduction-surgery is a well-stablished treatment for pulmonary emphysema; however, lobectomy is performed unfrequently in this indication. In a 48-years-old female with COPD stage GOLD IIIC with previous lower bilobectomy due to severe poststenotic pneumonia and multiple ineffective endobronchial-valves placements lower lobe lobectomy as LVRS was performed via anterolateral thoracotomy. FEV1 increased from 0,9l (31%) preoperative to 1,74l (59%) postoperative. This case demonstrates that in well selected patients, lobar resection for emphysema is feasible with good functional outcome even in patients after previous contralateral anatomic resection.
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Affiliation(s)
- Daniel Valdivia
- Department of Thoracic Surgery, University Medicine Essen - Ruhrlandklinik
| | | | - Clemens Aigner
- Department of Thoracic Surgery, University Medicine Essen - Ruhrlandklinik.
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10
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Hazelrigg SR. Looking Forward to Future Outcomes With a Control Group. Ann Thorac Surg 2020; 111:1865-1866. [PMID: 33144113 DOI: 10.1016/j.athoracsur.2020.07.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Stephen R Hazelrigg
- Cardiothoracic Surgery, Southern Illinois University School of Medicine, PO Box 19638, 800 N Rutledge, Rm D319, Springfield, IL 62794-9638.
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