Optimizing the selection of surgical candidates for lung volume reduction surgery

The optimal selection of patients for lung volume reduction surgery (LVRS) is currently based on empiric clinical findings. Patients who benefit from LVRS have the common characteristics of impaired quality of life associated with apical predominant pulmonary hyperinflation and airflow obstruction. Within this category, patients who do not benefit from LVRS appear to have small airways disease that can be detected by inspiratory resistance studies. In addition to appropriate emphysema physiology, the selection of patients for LVRS must consider medical comorbidities and perioperative risk factors. Based on findings of the National Emphysema Treatment Trial, most of the perioperative morbidity and mortality of LVRS is associated with cardiopulmonary risk that needs to be considered preoperatively. Finally, a preoperative conditioning program can provide an additional screening process to identify patients physically and emotionally prepared for surgery.