The preoperative selection of patients for emphysema surgery

Lung volume reduction surgery for emphysema is evolving rapidly since its re-introduction in 1993. Lung transplantation remains a viable option for others with emphysema. The major difficulty facing surgeons lies in appropriate selection of patients for either procedure. The following paper represents an attempt by review of the literature and personal experience to describe some of the important features involved in patient selection. The current literature on patient selection for lung volume reduction surgery and transplantation for emphysema was reviewed, and the results within the University of Toronto Lung Volume Reduction Program were analyzed. The review suggests that the most reliable predictors of success are heterogeneous distribution of emphysematous change as reflected by the CAT scan and the quantitative ventilation perfusion scan with new emphasis being placed on the ventilation portion of the latter. Poor prognostic indicators are hypercarbia and pulmonary hypertension. It was felt that an algorithm could be established for determination of whether lung volume reduction or transplantation should be offered to patients for emphysema surgery. The algorithm is described.