Outcomes of lung volume reduction surgery for emphysema: unilateral and bilateral

Lung volume reduction surgery (LVRS) has historically been performed as a bilateral operation. We aimed to compare the short-term morbidity and mortality between unilateral and bilateral LVRS.

We performed a retrospective analysis of patients who underwent LVRS for emphysema at two hospital sites over 10 years. Outcomes were compared between unilateral and bilateral LVRS by final approach. Functional outcomes included pulmonary functions tests (PFTs), 6-minute walk test (6MWT), and supplemental oxygen use.

A total of 119 patients underwent LVRS. A unilateral approach was used in 64 (54%) patients, and the bilateral approach in 55 (46%). For the entire cohort, functional outcomes significantly improved post-LVRS. Bilateral LVRS showed non-significant improvement in residual volume (RV%) (-77.5 vs. -45, P=0.07) and forced expiratory volume in the first second (FEV₁%) (+6.3% vs. +13%, P=0.07), and statistically significant improvement in diffusing capacity for carbon monoxide (DLCO%) (+2% vs. +9%, P=0.01), and 6MWT (-4 vs. +42.8, P=0.007) compared to the unilateral group. Procedure-related air leak (5 vs. 2.5, P=0.03) and chest tube days (7 vs. 4, P=0.01), and a longer hospital stay (8 vs. 5, P<0.001) were longer in the bilateral group compared to the unilateral group. Estimated survival at 1-year was 98.4% for unilateral and 90.9% for bilateral LVRS (P=0.09).

Compared to unilateral LVRS, bilateral LVRS is associated with a greater functional improvement at the expense of short-term morbidity.