Lung volume reduction surgery

An alternative to lung transplantation

Lung volume reduction surgery (LVRS) has been used increasingly in adults for treatment of breathlessness caused by severe emphysema.1 It is of particular benefit to patients with a heterogenous anatomic distribution of emphysema, with obvious target areas for resection,2 as it allows an improved chance of reclaiming function from surrounding compressed lung.3 We report on an 8-year-old male with obliterative bronchiolitis in whom LVRS has been used as a measure to significantly improve quality of life and avoid the immediate need for lung transplantation.

Lobar volume reduction surgery: a method of increasing the lung cancer resection rate in patients with emphysema

BACKGROUND

Guidelines on patient selection for lung cancer resection identify a predicted postoperative forced expiratory volume in 1 second (ppoFEV(1)) of <40% as a predictor of high risk. Experience with lung volume reduction surgery suggests that ppoFEV(1) may be underestimated in those with concomitant emphysema.

METHODS

Anatomical lobectomy was performed in 29 patients with a resectable lung cancer within a poorly perfused, hyperinflated emphysematous lobe identified by radionuclide perfusion scintigraphy and computed tomographic scanning. Perioperative changes in spirometric parameters at 3 months were compared in 14 patients (group A) of mean age 69 years (range 48-78) with ppoFEV(1) <40% (mean (SD) 31.4 (7)%) and 15 patients (group B) with ppoFEV(1) >40% (mean (SD) 47 (5)%). The correlation between predicted and actual postoperative FEV(1) was also assessed.

RESULTS

In group B there was a significant perioperative reduction in FEV(1) (p=0.01) but in group A FEV(1) did not change significantly after lobectomy (p=0.87); mean difference in perioperative change between groups A and B 331 ml (95% CI 150 to 510). Despite the difference in ppoFEV(1) between the groups, there was no difference in actual FEV(1) at 3 months. In-hospital mortality was 14% in group A and zero in group B, but at a median follow up of 12 (range 6-40) months there was no difference in survival between the groups.

CONCLUSIONS

Selection for lung cancer resection in patients with emphysema using standard calculations of ppoFEV(1) may be misleading. The effect of lobar volume reduction allows for an extension of the selection criteria.