Should lung volume reduction for emphysema be unilateral or bilateral?

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Medical Devices

Background:

• Severe, generalized emphysema is a debilitating condition.
• Lung volume reduction (LVR) procedures are used to treat emphysema.
• Both unilateral and bilateral LVR approaches are being explored.

Purpose of the Study:

• To compare the outcomes of unilateral versus bilateral thoracoscopic stapled lung volume reduction.
• To define the role of unilateral and bilateral LVR in severe emphysema management.

Main Methods:

• Analysis of 166 consecutive patients undergoing unilateral (n=87) or bilateral (n=79) thoracoscopic stapled LVR.
• Comparison of operative mortality, length of stay, morbidity, oxygen dependence, prednisone use, and FEV1 improvement.
• Subgroup analysis of especially compromised patients (age >= 75, low Po2 or FEV1).

Main Results:

• No significant differences in operative mortality, length of stay, or morbidity between unilateral and bilateral LVR.
• Bilateral LVR showed significantly higher rates of eliminating oxygen dependence (68% vs 36%) and prednisone use (85% vs 54%).
• Bilateral LVR resulted in a greater mean improvement in FEV1 (57% vs 31%), with 72.8% improvement for upper lobe emphysema.

Conclusions:

• Bilateral thoracoscopic stapled lung volume reduction is the preferred procedure for severe emphysema, offering superior results.
• The bilateral approach provides better functional outcomes without increased morbidity or mortality compared to unilateral LVR.
• Results of bilateral stapled LVR via thoracoscopy are comparable to those achieved with median sternotomy.