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Objective predictors of response for staple versus laser emphysematous lung reduction
1Department of Medicine, University of California Irvine Medical Center, Chapman General Hospital, Orange 92668, USA.
Summary
Younger patients with severe emphysema and lung hyperinflation may benefit most from lung volume reduction surgery, particularly the staple technique. Objective preoperative factors can help identify optimal candidates for improved outcomes.
Area of Science:
- Pulmonary Medicine
- Thoracic Surgery
- Medical Imaging
Background:
- Surgical lung volume reduction (LVR) for emphysema has variable outcomes.
- Objective preoperative factors are needed to guide patient selection for LVR.
Purpose of the Study:
- To identify objective preoperative predictors of treatment response in emphysema patients undergoing LVR.
- To define patient selection criteria for staple versus laser LVR procedures.
Main Methods:
- Seventy-two severe emphysema patients (no bullae) were randomized to staple (39) or laser (33) LVR.
- Preoperative pulmonary function tests, smoking history, demographics, and CT scans were analyzed.
- Linear and multivariate regression assessed predictors of forced expiratory volume in 1 second (FEV1) change at 3-6 months.
Main Results:
- Overall improvement was significant only for staple-treated patients.
- For staple LVR, greater smoking history and younger age predicted better outcomes.
- For laser LVR, greater smoking history, lower diffusing capacity for carbon monoxide (DLCO), and younger age predicted better outcomes.
- CT-identified hyperinflation predicted response in laser-treated patients.
Conclusions:
- Younger patients with advanced emphysema and hyperinflation are optimal candidates for LVR, especially using staple techniques.
- Further studies are needed to refine operative criteria for LVR in emphysema.