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New simple classification for operated bullous emphysema.
Tommaso Claudio Mineo1, Vincenzo Ambrogi, Eugenio Pompeo
1Thoracic Surgery Division and Emphysema Center, Policlinico Tor Vergata University, Rome, Italy.
The Journal of Thoracic and Cardiovascular Surgery
|November 21, 2007
Summary
The ratio of bulla volume to residual volume predicts bullectomy success. A higher bulla/residual volume ratio indicates better and more durable improvements in respiratory function after surgery for emphysematous bulla.
Area of Science:
- Pulmonary Medicine
- Thoracic Surgery
- Respiratory Physiology
Background:
- Bullectomy is a surgical procedure to remove enlarged air spaces (bullae) in the lungs.
- Optimal outcomes depend on resected bulla volume and healthy lung reexpansion.
- A prognostic classification based on bulla and residual volumes is needed.
Purpose of the Study:
- To evaluate the relationship between bulla volume, residual volume, and bullectomy outcomes.
- To propose a new prognostic classification system for bullectomy patients.
Main Methods:
- Retrospective review of 121 patients undergoing bullectomy.
- Measurement of bulla volume (CT) and residual volume (body plethysmography).
- Analysis of 6-month and 5-year postoperative residual volume changes using logistic regression and ROC curve analysis.
Main Results:
- No postoperative mortality.
- Improved respiratory function correlated with bulla size.
- Bulla/residual volume ratio was the most predictive variable for improved and sustained residual volume reduction (cutoffs at 20% and 30%).
Conclusions:
- Bullectomy offers good results, with outcomes significantly influenced by the bulla/residual volume ratio.
- Ratios <20% yield scant improvement, 20-30% yield good but temporary improvement, and >30% yield good and long-lasting results.
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