[Lung Volume Reduction Surgery - an Alternative or a Bridge to Transplantation]

Lung volume reduction surgery (LVRS) and lung transplantation (LuTX) are established therapeutic options for patients with advanced pulmonary emphysema. This review analyses both procedures with respect to indications, surgical techniques, outcomes, and complications. Special attention is given to the controversial sequential application as a bridge to transplantation. Evidence shows that both procedures can significantly improve lung function, quality of life, and survival when patients are carefully selected. Despite some overlap in indication criteria, most patients qualify for only one of the procedures as based on their specific clinical constellation. Recent research has challenged traditional contraindications such as pulmonary hypertension or homogeneous emphysema, and consequently, the indication spectrum for LVRS has been expanded. Contrary to earlier assumptions, current multicentre studies demonstrate that prior LVRS has no negative impact on subsequent transplantation outcomes, provided minimally invasive surgical techniques and modern perioperative management are employed. LVRS can delay the need for transplantation, which is a significant advantage given the shortage of donor organs. The key to success lies in interdisciplinary evaluation and personalized treatment planning. Both procedures should be understood as complementary rather than competing options. Future research should focus on predictive biomarkers, optimal timing, and combined patient-centred endpoints.