EACTS Expert Consensus Document on Lung Volume Reduction for Emphysema

Emphysema is a major burden for health care, both in terms of use of hospital resources and of community services. Medical therapies are limited and may only palliate symptoms, whereas lung volume reduction (LVR) has been shown to provide further benefit for those on maximal medical therapy who meet the selection criteria. However, LVR remains a considerably underutilized intervention partly due to a paucity of practice guidelines. Lung volume reduction can be obtained by 2 main methods: Lung volume reduction surgery (LVRS) and endobronchial lung volume reduction (EBLVR). There have been expert statements on EBLVR, but this is the first multidisciplinary statement also to consider lung volume reduction surgery (LVRS). In a comprehensive, literature-based review, all aspects of LVR are considered. Selection criteria for both LVR methods are simplified as far as possible, and advice is given to aid multidisciplinary decision-making. Each technique is individually examined with technical points and practice advice, and the factors determining when either is used are explained. Where no clear comparative evidence is available, the pros and cons of each debate are clearly illustrated. The inter-relationship with a lung transplant is explored in a constructive, collaborative way. The benefits of LVR are detailed, but importantly, so are the perioperative risks. Clear management plans are outlined utilizing the multidisciplinary team. Finally, the importance of and recommendations for follow-up protocols are stated. This unique initiative brings together experts from across the disciplines involved in offering lung volume reduction, and a consensus has been achieved in all aspects, indicating the widespread implications for the statements.