[Surgical treatment for pulmonary emphysema--LVRS/lung transplantation]

Lung volume reduction surgery (LVRS) for severe pulmonary emphysema was started more than 10 years ago. However, its indication and durability of effects had not been clear. The National Emphysema Treatment Trial (NETT) defined patients at high risk of death after LVRS and subgroups of patients with severe emphysema in whom LVRS improved survival and function. Those effects are durable, when LVRS is applied to an appropriate subgroup like upper lobe predominant emphysema patients with low exercise capacity. However, only one-fourth of LVRS candidates are belonging to such a preferable subgroup. Although most of the patients with severe pulmonary emphysema are over 60 years old in Japan, candidates for lung transplantation are limited under 60. Under such a condition, only two patients with severe pulmonary emphysema have undergone lung transplantation in Japan.