Repeated lung volume reduction surgery is successful in selected patients

Area of Science:

• Thoracic surgery
• Pulmonary medicine
• Emphysema treatment

Background:

• Lung volume reduction surgery (LVRS) is established for end-stage emphysema, improving quality of life and survival.
• Benefits of LVRS may diminish over time due to disease progression.
• Data on repeated LVRS (Re-LVRS) are limited.

Purpose of the Study:

• To evaluate the safety, effects, and outcomes of Re-LVRS in patients with advanced emphysema no longer benefiting from initial LVRS.
• To assess lung function, quality of life, and complications associated with Re-LVRS.

Main Methods:

• A cohort of 22 patients with advanced emphysema underwent Re-LVRS between 2002 and 2013.
• Re-LVRS was performed unilaterally using video-assisted thoracoscopic surgery or thoracotomy.
• Pulmonary function tests (PFTs) were conducted at 3 and 12 months postoperatively.

Main Results:

• Re-LVRS showed a 0% 90-day mortality rate, with improved lung function (FEV1 increase of 25%) and reduced dyspnea (MRC score decrease from 3.7 to 2.2) for up to 12 months.
• The most common complication was prolonged air leak (32% required reoperation), leading to longer hospitalization compared to initial LVRS.
• Despite complications, 23% of patients experienced no adverse events, and outcomes were comparable to initial LVRS.

Conclusions:

• Re-LVRS is a feasible palliative treatment for carefully selected emphysema patients.
• It can serve as a bridge to lung transplantation or be performed in conjunction with other surgeries.
• Acceptable morbidity and satisfactory outcomes, including improved lung function and reduced dyspnea, support Re-LVRS for select patients.