Surgical treatment of severe emphysema--analysis of own material

The aim of the study was a retrospective analysis of effectiveness of surgical treatment of severe diffuse emphysema, including urgent cases with symptomatic pneumothorax. We analyzed 99 patients with severe diffuse emphysema who underwent surgical treatment in Department of Thoracic Surgery in Lublin between 1995 and 2001. The evaluated group consisted of 86 men and 13 women aged from 27 to 83 (mean age 56.6). Among them 54 were operated on due to sudden pneumothorax, which was a result of bursted emphysematous parenchyma. Those patients were not evaluated with spirometry and CT of the chest. All the other patients were carefully examined and qualified for surgical treatment according to precise criteria: presence of clinical and radiological symptoms of diffuse severe emphysema (DSE), FEV1<35%, pCO2>50mmHg. Those 43 patients eligible for Lung Volume Reduction Surgery iLVRS) also did not have any main contraindications for lung surgery. In the whole analyzed population 89 resections were unilateral, limited to 20-25% of the most destroyed tissue. In 10 cases operation was bilateral, among them four were simultaneous and the remaining six were not. In our study we evaluated the frequency and degree of complications, early results of treatment, influence of surgery on selected parameters: FEV1, pCO2, subjective dyspnea according to Medical Research Council Dyspnea Scale. We observed three perioperative deaths. The most common complications were air leak> five days, cardiopulmonary insufficiency, pneumonia. Early results showed subjective decrease of dyspnea and in most cases improvement of the analyzed parameters.

The early results are optimistic and correspond to the observations of other authors. Further analysis of the collected data and long term results will allow establishing the role of LVRS in treatment of Diffuse Severe Emphysema.