Comparison of Outcomes Between Anatomical and Traditional Lung Volume Reduction Surgery for Severe Emphysema

Background: Anatomical lung resection is performed in cancer patients with severe emphysema who may also benefit from lung volume reduction (LVR). However, anatomical lung volume reduction surgery (LVRS) for emphysema alone is uncommon. This study compares the outcomes of anatomical and traditional LVRS. Methods: Patients undergoing surgery for emphysema were retrospectively analysed. They were grouped as anatomical LVRS (A-LVRS) and traditional LVRS (T-LVRS) patients. Various outcomes were compared between groups. Results: Thirty-three (33) patients were divided into A-LVRS (14) and T-LVRS (19) groups. The mean age was 62.1 ± 8.8 and 17 (51.5%) were females. Demographic and preoperative variables were similar between these groups. Overall complications, length of stay (LOS), critical care complex (CCC) re-admission, CCC-LOS and hospital re-admissions were similar. Drain stay duration was shorter in the A-LVRS vs. the T-LVRS group (6.4 vs. 12.6 days, respectively, p = 0.042) and air leak-related complications were also fewer in the A-LVRS group (21.4% vs. 57.9%, respectively, p = 0.036). Reduction in the COPD assessment test was greater in the A-LVRS vs. T-LVRS group (17 vs. 7.8, p = 0.045). Forced expiratory volume 1 s (FEV₁) was improved by 8.25% in the A-LVRS vs. 2.9% in the T-LVRS group (p = 0.049). The lung transfer factor for carbon monoxide (TLCO) increased by 7.9% in the A-LVRS group versus a decrease of -1.01% in the T-LVRS group (p = 0.031). More lung volume was removed in the A-LVRS vs. the T-LVRS group (1625.4 vs. 352.4 cm³, p = 0.035). In-hospital/30-day/90-day deaths and long-term survival were similar. Conclusions: Anatomical LVRS is safe and may provide better outcomes in selected parameters compared with traditional LVRS.