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[What place for lung volume reduction surgery for emphysema?]
J De Wolf1, P Bonnette1, É Sage1
1Service de chirurgie thoracique et transplantation pulmonaire, hôpital Foch, 92150 Suresnes, France.
Revue Des Maladies Respiratoires
|July 23, 2016
Summary
Lung volume reduction surgery (LVRS) improves survival and quality of life in select emphysema patients, particularly those with upper-lobe disease. However, LVRS is underutilized despite proven benefits.
Area of Science:
- Pulmonary Medicine
- Thoracic Surgery
Background:
- Lung volume reduction surgery (LVRS) is a therapeutic option for severe emphysema.
- The National Emphysema Treatment Trial (NETT) provided key insights into LVRS efficacy and patient selection.
Observation:
- LVRS demonstrated a 5-year improvement in survival, exercise capacity, and quality of life in specific emphysema patient groups.
- Optimal candidates for LVRS typically present with upper-lobe-predominant emphysema and low exercise capacity.
Findings:
- Specific inclusion criteria for LVRS include FEV1≤45%, TLC≥100%, RV≥150%, PaCO2≤60mmHg, and PaO2≥45mmHg.
- Patients with FEV1≤20% and DLCO<20% or homogeneous emphysema face increased mortality risk and are generally excluded from LVRS.
Implications:
- Despite evidence, LVRS is infrequently performed, facing competition from lung transplantation and emerging endoscopic volume reduction techniques.
- Careful patient selection based on established criteria is crucial for optimizing outcomes and minimizing risks associated with LVRS.
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