Connecting the dots: historical perspective on lung volume reduction.

Area of Science:

• Pulmonology
• Thoracic Surgery
• Respiratory Medicine

Background:

• Lung volume reduction (LVR) has a century-long history for advanced emphysema treatment.
• Early surgical methods had high risks and variable results.
• Advances in physiology, imaging, and patient selection have driven modern LVR strategies.

Purpose of the Study:

• To review the historical evolution of LVR for emphysema.
• To highlight key innovations and their impact on current practices.
• To discuss future directions in emphysema management through LVR.

Main Methods:

• Narrative review of historical and contemporary LVR literature.
• Analysis of surgical and bronchoscopic LVR techniques.
• Examination of patient selection criteria and outcomes.

Main Results:

• Early LVR approaches were limited by morbidity and inconsistent outcomes.
• The National Emphysema Treatment Trial emphasized phenotype-based patient selection.
• Bronchoscopic lung volume reduction (BLVR), particularly with endobronchial valves (EBVs), has a strong evidence base.
• Minimally invasive and robotic techniques, along with expanded indications, broaden LVR's scope.
• LVR is increasingly used adjunctively with lung transplantation.

Conclusions:

• Historical successes and failures inform current LVR practices.
• Understanding collateral ventilation and fissure integrity is crucial for EBV efficacy.
• Multidisciplinary evaluation and personalized medicine will shape the future of LVR for emphysema.