Patient-directed Volume Reduction for Emphysema: Sequential Surgical and Endobronchial Techniques

Area of Science:

• Pulmonology
• Thoracic Surgery
• Respiratory Medicine

Background:

• Traditional lung volume reduction (LVR) surgery involves 1-stage bilateral or predetermined staged procedures.
• This study explored a protocol allowing patient-determined timing for interventions and incorporating endobronchial LVR.
• Long-term outcomes of this modified LVR approach were reviewed.

Purpose of the Study:

• To evaluate the long-term efficacy and outcomes of a flexible, staged approach to lung volume reduction (LVR) surgery.
• To assess the impact of incorporating endobronchial LVR and patient-determined timing on surgical benefits.
• To analyze physiological and health status improvements following staged LVR.

Main Methods:

• 331 LVR procedures were performed on 254 patients with severe COPD (FEV1 28% ± 11%).
• Procedures included video-assisted thoracoscopic surgery (VATS), open surgery, and endobronchial valve insertion.
• A staged approach was utilized, with some patients receiving second (n=64) or third (n=13) procedures at patient-determined intervals.

Main Results:

• Staged LVR significantly improved forced expiratory volume in 1 second (FEV1) from 28% to 34% for up to 6 years.
• Static lung volumes showed sustained reduction, with residual volume decreasing from 259% to 189% for up to 8 years.
• Health status improved significantly (EuroQol-5D, SF-36) for up to 5-9 years, with 30-day mortality at 3% and median survival of 5.6 years.

Conclusions:

• A program of staged, unilateral lung volume reduction (LVR) procedures provides sustained physiological and health status benefits for up to 9 years.
• This flexible, staged approach, including endobronchial methods, enhances long-term outcomes for carefully selected patients.
• The findings support LVR as an effective intervention for managing severe emphysema and improving quality of life.