Lung volume reduction surgery for emphysema.
OBJECTIVE
To report the results of lung volume reduction surgery (LVRS) for severe emphysema in Australia.


METHODS
A tertiary teaching hospital.


METHODS
A prospective study of a consecutive case series.


METHODS
20 patients (mean age, 56 years) with severe emphysema--mean forced expiratory volume in one second (FEV1), 0.72 L (28% of predicted) and severe gas trapping (mean residual volume, 286% of predicted).


METHODS
Bilateral apical LVRS was performed via a median sternotomy with a linear stapler; bovine pericardial strips were used to reinforce the staple line.


RESULTS
There was a 95% survival, and a mean (range) inpatient stay of 17 (8-45) days. No complications occurred in nine patients; a further six patients had only minor complications. Five patients had major complications (sputum retention requiring reintubation, persistent air leak requiring reoperation, duodenal perforation, and epidural haemorrhage); one patient died from multiorgan failure at 28 days. Intercostal drainage was left in situ for a mean of eight days. The results of FEV1, Medical Research Council (MRC) Dyspnoea Score and six-minute walk test improved in more than 90% of patients. FEV1 improved an average of 0.35 L (54% over baseline) (P < 0.001). Mean MRC Dyspnoea Score decreased from 3.4 to 2.1 (P < 0.001). Mean distance for the six-minute walk test increased from 306 to 431 metres (P < 0.001).


CONCLUSIONS
Our experience confirms that LVRS produces worthwhile early outcomes for a subgroup of patients with severe emphysema. The clinical, economic and ethical questions raised by this new therapy will need to be assessed.
Snell
G I
GI
Department of Respiratory Medicine, Alfred Hospital, Melbourne, VIC.
Solin
P
P
Chin
W
W
Rabinov
M
M
Williams
T J
TJ
Esmore
D S
DS
Smith
J A
JA
D000328:Adult; D000368:Aged; D004646:Emphysema / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D005080:Exercise Test; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D011446:Prospective Studies; D012115:Residual Volume; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome