[Four-year results after lung volume reduction surgery for emphysema].
OBJECTIVE
While the short-term results of lung volume reduction surgery are known, follow-up over several years has not often been described. The purpose of the present study was to describe results in terms of functional improvement, dyspnea, quality of life, and mortality over a 4-year period in patients with advanced emphysema.


METHODS
Fourteen successive patients were enrolled between 1996 and 2000 and studied prospectively for 4 years. All patients served as their own controls and initially received pulmonary rehabilitation and medication. Preoperative data were used as baseline and were compared to postoperative data over 4 years. The data analyzed were: functional improvement (forced expiratory volume in 1 second [FEV1]), quality of life, dyspnea, and patient loss due to death or referral to a lung transplantation program.


RESULTS
Patients with advanced emphysema (mean FEV1 [SD]: 22.8% [11%] of predicted) were studied. Postoperative mortality was 14%. Overall mortality (postoperative plus deaths due to respiratory insufficiency) was 28% at 1 year and 35% at 4 years. Two patients died of cancer and 5 were referred for transplantation. At 3 months, FEV1 had improved more than 15% in 9 patients (64%); the improvement was maintained in 43% of patients at 1 year and 7% at 4 years. Improvement in dyspnea paralleled improvement in FEV1. Overall, at 3 months mean FEV1 had improved 41.9% (68%), transitional dyspnea index 2.7 (3), and quality of life questionnaire score 1 (0.9). Thus, improvements were considerable, but there was great variation. Preoperative mean decrease in FEV1 was 50 (32) mL/y, and postoperative decrease 194 (70) mL/y.


CONCLUSIONS
With the inclusion criteria used, there was considerable variation in the results. Significant overall functional improvement was maintained in 50% of the patients 1 year following surgery and in 7% 4 years after surgery. Given such results, together with a surgical mortality rate of 14% and overall mortality of 28% in the first year, we believe that the criteria for using lung reduction surgery should be revised.
Juan Samper
G
G
Unidad de Neumología, Departamento de Medicina, Facultad de Medicina, Universidad de Valencia, Valencia, Spain. gustavo.juan@uv.es
Ramón Capilla
M
M
Cantó Armengol
A
A
Martínez Pérez
M L
ML
Lloret Pérez
T
T
Rubio Gomis
E
E
Marín Pardo
J
J
D000368:Aged; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008875:Middle Aged; D011013:Pneumonectomy; D011446:Prospective Studies; D011656:Pulmonary Emphysema / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011788:Quality of Life; D013997:Time Factors