Lung volume reduction for severe emphysema: do we need a scalpel or a scope?

Area of Science:

• Pulmonary Medicine
• Thoracic Surgery
• Interventional Pulmonology

Background:

• Surgical lung volume reduction (LVR) offers benefits for select emphysema patients.
• This procedure has significant pulmonary and cardiovascular morbidity and mortality risks.
• Current LVR excludes patients with homogeneous emphysema.

Purpose of the Study:

• To evaluate less invasive, non-resectional endoscopic lung volume reduction (ELVR) techniques.
• To compare ELVR outcomes with traditional surgical LVR.
• To explore ELVR's potential for patients with homogeneous emphysema.

Main Methods:

• Review of existing data and ongoing randomized trials on ELVR techniques.
• Comparison of morbidity and mortality rates between surgical LVR and emerging ELVR methods.
• Assessment of potential benefits for patient groups currently excluded from surgical LVR.

Main Results:

• Surgical LVR demonstrates superiority in reducing dyspnea and improving lung function, survival, and quality of life in carefully selected patients.
• Significant risks associated with surgical LVR include prolonged air leak, pulmonary, and cardiovascular complications.
• Ongoing trials are investigating endoscopic alternatives like endobronchial valves, airway bypass stents, and biological adhesives.

Conclusions:

• Endoscopic lung volume reduction (ELVR) techniques hold promise for achieving similar improvements to surgical LVR with potentially lower morbidity and mortality.
• ELVR may expand treatment options to include patients with homogeneous emphysema.
• Further results from randomized trials are crucial to confirm the efficacy and safety of ELVR compared to surgical resection.