Lung volume reduction surgery for emphysema

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 pericardial 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 (MRC) 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 MRC 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.