[Surgical emphysema reduction: A viable alternative in the era of endobronchial valves]

Management of patients with chronic obstructive pulmonary disease (COPD) and severe emphysema is complex. While endobronchial valve placement has become a widespread option, lung volume reduction surgery (LVRS) remains an important but sometimes underused alternative. Selecting the most appropriate intervention requires a multidisciplinary approach, especially for lung transplantation candidates.

We report the case of a 57-year-old male former smoker referred for lung transplantation due to advanced COPD with severe upper-lobe predominant emphysema and pronounced pulmonary hyperinflation. The patient had disabling dyspnea (mMRC 3), a BODE index of 6, and major pulmonary function impairment (forced expiratory volume at 1st second [FEV₁] 31% predicted; residual volume 329% predicted). After multidisciplinary discussion and StratX® analysis, the patient underwent right upper lobectomy. Six months postoperatively, he had experienced significant symptomatic and functional improvement: FEV₁ had increased to 56% predicted, residual volume had decreased to 191%, and V˙O₂ max had improved. Ventilation efficiency and gas exchange likewise improved. Diaphragmatic ultrasound demonstrated enhanced mobility and thickening.

This case highlights the interest of LVRS in carefully selected patients with severe emphysema, which remains viable in the era of bronchoscopic interventions. LVRS can provide clinical and functional benefits, improve quality of life, and in some cases delay lung transplantation. It remains an essential part of the therapeutic arsenal for end-stage emphysema and should be considered in multidisciplinary evaluations.