Lung volume reduction surgery in the post-National Emphysema Treatment Trial era

Lung volume reduction surgery (LVRS) as means to improve the pulmonary function and quality of life of patients with chronic obstructive pulmonary disease (COPD) can be traced back to the 1950's and early work by Otto Brantigan. Joel Cooper revived this concept with pioneering work in the 1990's. His work, along with others, led to the National Emphysema Treatment Trial (NETT) which demonstrated a quality of life and survival benefit for certain subsets of patients with emphysema. While the outcomes of carefully selected patients are excellent, with proven benefits in both quality of life and overall survival, the volume of LVRS being performed remains low. The procedure is highly regulated in the United States and is only performed in Centers for Medicare and Medicaid Services (CMS) approved programs. Programs are required to follow the NETT selection criteria. The program at Columbia University Medical Center/New York Presbyterian Hospital remains active. Utilizing the NETT criteria, we continue to perform LVRS with no operative mortality and excellent long-term outcomes.