title: Bilateral apical vs nonapical stapling resection during lung volume reduction surgery.
abstract: OBJECTIVE
  To determine whether biapical stapling resection alone or resection of diseased, nonapical areas of emphysematous lung provides comparable physiologic outcomes or alters morbidity and mortality after lung volume reduction surgery (LVRS).
  
  
  METHODS
  Consecutive case-series analysis.
  
  
  METHODS
  Urban university hospital.
  
  
  METHODS
  Forty-seven patients ([mean +/- SD] aged 58+/-8 years; 18 men) with severe emphysema (FEV1, 0.7+/-0.2 L; total lung capacity [TLC], 139+/-23% predicted).
  
  
  METHODS
  Thirty-two patients underwent biapical LVRS, 27 by median sternotomy (MS) and 5 by video-assisted thoracoscopic surgery (VATS), and 15 underwent nonapical resection, 9 by MS and 6 by VATS. Patients were assessed for postoperative complications (respiratory tract infections, air leak duration, and death), length of stay, and physiologic parameters, which included a 6-min walk distance, spirometry, lung volume, gas exchange, diaphragm strength, and quality-of-life measures.
  
  
  RESULTS
  Patients were studied at baseline and at 3 months postoperatively. At the preoperative baseline, both groups had similar ages (57 vs 60 years; p = 0.2), 6-min walk distance (294 vs 263 m; p = 0.3), FEV1 (28% vs 29% predicted; p = 0.6), degree of hyperinflation (TLC, 138% vs 141% predicted; p = 0.8), gas exchange (PaO2/fraction of inspired oxygen, 344 vs 313, p = 0.1; PaCO2 46 vs 48 mm Hg, p = 0.4), and diaphragm strength (maximal transdiaphragmatic pressure sniff, 54 vs 46 cm H2O, p = 0.4). Resected tissue weight was similar in both groups (94 vs 93 g, p = 0.9). There were no differences in the mean percentage of change from baseline for these physiologic parameters or for quality-of-life measures between the two groups. The 6-min walk distances increased by 20% and 33%, FEV1 increased by 37% and 38%, the degrees of hyperinflation (residual volume/TLC) decreased by 16% and 15%, and the quality-of-life scores improved by 51% and 41%, respectively, in the groups that underwent biapical and nonapical resections at 3 months post-LVRS. The length of stay in the hospital for LVRS (18 vs 23 days; p = 0.4) and the duration of air leak (10 vs 15 days; p = 0.4) were also similar. Complications between the two groups (biapical vs nonapical) were similar (respiratory tract infection, 47% vs 60%, p = 0.2; reintubation, 34% vs 33%, p = 0.2; reoperation, 9% vs 20%, p = 0.4; and death, 9% vs 7%, p = 0.2).
  
  
  CONCLUSIONS
  LVRS, by biapical or nonapical resection, produces similar improvements in lung function, exercise, diaphragm strength, and quality of life, with comparable morbidity and mortality.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, and Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA 19140, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Travaline
authors.forename: S
authors.initials: S
authors.lastname: Furukawa
authors.forename: A M
authors.initials: AM
authors.lastname: Kuzma
authors.forename: G M
authors.initials: GM
authors.lastname: O'Brien
authors.forename: G J
authors.initials: GJ
authors.lastname: Criner
mesh_terms: D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011183:Postoperative Complications; D011656:Pulmonary Emphysema / Q000503:physiopathology / Q000601:surgery*; D011788:Quality of Life; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D015996:Survival Rate; D013537:Sutures; D013906:Thoracoscopy; D016896:Treatment Outcome