Lung volume reduction surgery and lung volume reduction in advanced emphysema: who and why?
Emphysema is a disabling and progressive disease that is hallmarked by decreased exercise tolerance and impaired quality of life. Hyperinflation is the sentinel physiological characteristic of emphysema that has been shown to be responsible for exercise intolerance, dyspnea, impaired quality of life, and mortality. Surgical interventions that reduce lung volume have been the focus of multiple proposed interventions over the past century; however, evidence documenting their effectiveness has been lacking. Recently, lung volume reduction surgery (LVRS) has undergone rigorous study in the National Emphysema Treatment Trial (NETT) that documented its short and long-term effectiveness, associated morbidity and mortality, and essential characteristics that predict success or failure. Additional recent investigation has examined the use of less invasive techniques, predominantly bronchoscopic techniques that reduce lung volume without open thoracotomy. This article summarizes the major results of the NETT and briefly reviews some preliminary results of studies examining new techniques of bronchoscopic lung volume reduction.
Criner
Gerard J
GJ
Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA. crinerg@tuhs.temple.edu
Mamary
A James
AJ
D000818:Animals; D001999:Bronchoscopy / Q000379:methods*; D017079:Exercise Tolerance; D006801:Humans; D011013:Pneumonectomy / Q000379:methods*; D011656:Pulmonary Emphysema / Q000503:physiopathology / Q000601:surgery*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D016896:Treatment Outcome