title: Lung-volume reduction surgery as an alternative or bridging procedure to lung transplantation.
abstract: BACKGROUND
  In this study, we prospectively analyzed the functional outcome and the survival after lung-volume reduction surgery (LVRS) in patients with end-stage emphysema who were initially potential candidates for lung transplantation (LTX), and investigated the impact of LVRS on posttransplant course in patients who underwent LTX after LVRS.
  
  
  METHODS
  Of the 216 patients who underwent LVRS between 1994 and 2005, 58 were potential candidates for LTX at the time of LVRS (age 65 years or younger, forced expiratory volume in 1 second 25% of predicted or less; LVRS/LTX group). Lung-volume reduction surgery was performed by means of video-assisted, bilateral stapled resection of target areas. During the same period, 31 patients underwent primary LTX for end-stage emphysema (LTX group). Spirometry, plethysmography, carbon monoxide diffusing capacity, 6-minute walking distance, and dyspnea score were assessed preoperatively and at predetermined times after operation. Survival analysis was performed by use of the Kaplan-Meier method.
  
  
  RESULTS
  All the functional variables significantly improved after LVRS and peaked within the first year. Subjective improvement was observed for up to 5 years after LVRS, and 53% (31 of 58) of the patients were still alive and had not undergone transplantation after a median follow-up of 44 months. Fourteen percent (8 of 58) of the patients underwent secondary LTX because of progressive worsening of the respiratory function after a median bridging time between LVRS and LTX of 33 months. Postoperative recovery after transplantation and median survival time were comparable between the 8 patients of the LVRS/LTX group and the 31 patients of the LTX group (96.5 months versus 118.5 months, p = 0.9).
  
  
  CONCLUSIONS
  Lung-volume reduction surgery can significantly improve symptoms and lung function in selected patients who are initially potential candidates for LTX. Lung-volume reduction surgery can allow the postponement of LTX for up to 4 to 5 years and does not impair the chances for a subsequent successful LTX.
authors.affiliation: Department of Thoracic Surgery, and Division of Pulmonary Medicine, University Hospital, Zurich, Switzerland.
authors.forename: Michaela
authors.initials: M
authors.lastname: Tutic
authors.forename: Didier
authors.initials: D
authors.lastname: Lardinois
authors.forename: Stephan
authors.initials: S
authors.lastname: Imfeld
authors.forename: Stephan
authors.initials: S
authors.lastname: Korom
authors.forename: Annette
authors.initials: A
authors.lastname: Boehler
authors.forename: Rudolf
authors.initials: R
authors.lastname: Speich
authors.forename: Konrad E
authors.initials: KE
authors.lastname: Bloch
authors.forename: Erich W
authors.initials: EW
authors.lastname: Russi
authors.forename: Walter
authors.initials: W
authors.lastname: Weder
mesh_terms: D000328:Adult; D000368:Aged; D002248:Carbon Monoxide / Q000032:analysis; D004417:Dyspnea / Q000209:etiology; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D015993:Life Tables; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D010991:Plethysmography; D011013:Pneumonectomy; D011446:Prospective Studies; D011656:Pulmonary Emphysema / Q000401:mortality / Q000601:surgery*; D012720:Severity of Illness Index; D013147:Spirometry; D017792:Surgical Stapling; D016019:Survival Analysis; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome; D014850:Waiting Lists
chemical_list: D002248:Carbon Monoxide