Bullectomy is comparable to lung volume reduction in patients with end-stage emphysema.
OBJECTIVE
Emphysema is one of the most prevalent disabling diseases, not modified by current medical treatment and physical rehabilitation. Lung transplantation is an effective clinical option in end-stage emphysema but it is available only for a limited number of patients. Bullectomy and lung volume reduction represent other surgical options to improve symptoms and exercise tolerance in selected patients. Both procedures allow the removal of the area of emphysematous lung resulting in improvement in chest wall mechanics, ventilation/perfusion ratio and re-expansion and better function of the residual lung. There is some evidence that in patients with end-stage emphysema bullectomy and lung volume reduction work in the same manner and yield similar functional results.


METHODS
We compared and analyzed retrospectively two groups of patients with end-stage emphysema who underwent bullectomy or lung volume reduction. Over the last 5 years 20 patients with end-stage emphysema presenting with bullae underwent thoracoscopic bullectomy (Group I). During the same period of time 18 patients with end-stage non-bullous emphysema underwent thoracoscopic unilateral lung volume reduction. Pre-operative baseline respiratory function data, peri-operative data, and functional results recorded at 6 and 12 months were compared and analyzed.


RESULTS
Both groups were homogeneous in terms of age, degree of respiratory derangement and severity of emphysema. Complication rate and peri-operative data were similar in the two groups. Improvement in symptoms, respiratory function and exercise tolerance was comparable.


CONCLUSIONS
Our experience supports the hypothesis that the physiopathological basis of respiratory improvement after bullectomy and lung volume reduction surgery in patients with end-stage emphysema is the same, although the exact mechanism remains incompletely understood.
Department of Thoracic Surgery, University of Rome La Sapienza, Policlinico Umberto I, V.le Policlinico, 00161 Rome, Italy. tdegiac@tin.it
Tiziano
T
De Giacomo
Erino Angelo
EA
Rendina
Federico
F
Venuta
Marco
M
Moretti
Edoardo
E
Mercadante
Ibrahim
I
Mohsen
Mary-Jo
MJ
Filice
Giorgio Furio
GF
Coloni
D000368:Aged; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011183:Postoperative Complications; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D015656:Respiratory Mechanics; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed