Elsevier

The Annals of Thoracic Surgery

Volume 68, Issue 5, November 1999, Pages 1792-1798
The Annals of Thoracic Surgery

Original Articles
Two years’ outcome of lung volume reduction surgery in different morphologic emphysema types

Presented at the Thirty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 25–27, 1999.
https://doi.org/10.1016/S0003-4975(99)00990-XGet rights and content

Abstract

Background. Lung volume reduction surgery (LVRS) improves dyspnea, pulmonary function, and quality of life in selected patients with severe emphysema. We investigated the role of emphysema morphology in 37 patients as an outcome predictor for up to 2 years after operation.

Methods. Patients selected for bilateral thoracoscopic LVRS were divided, according to a simplified emphysema morphology classification, into three groups (homogeneous, moderately heterogeneous, and markedly heterogeneous) based on a preoperative chest computed tomogram. Pulmonary function, walking distance, and dyspnea were assessed.

Results. Functional improvement after LVRS was best in markedly heterogeneous emphysema with an increase from preoperative forced expiratory volume in 1 second of 31% ± 2% (mean ± standard error of the mean) to 52% ± 4% of predicted postoperatively. It was significantly higher than in homogeneous emphysema (from 26% ± 1% to 38% ± 2% predicted) and in intermediately heterogeneous emphysema (from 29% ± 2% to 44% ± 45% predicted). At 24 months postoperatively, forced expiratory volume in 1 second and dyspnea score continued to be significantly better than preoperative levels in all three morphologic groups. The survival rate was highest in patients with markedly heterogeneous emphysema.

Conclusions. Functional and subjective improvements were maintained after LVRS for at least 24 months in patients with heterogeneous or homogeneous emphysema type.

Section snippets

Whole cohort

A total of 101 consecutive emphysema patients (38 women) had bilateral LVRS by video-assisted thoracoscopy at our institution between August 1994 and December 1998. Their mean age (± standard error of the mean) at operation was 63 ± 1 years (range, 38 to 78 years). They were severely symptomatic with a mean modified Medical Research Council dyspnea score of 3.6 ± 0.1 and had severe airflow obstruction with a mean forced expiratory volume in one second (FEV1) of 0.78 ± 0.02 L, which was 28% ± 1%

Preoperative findings

The mean age at operation was 66 ± 2 years and did not differ in the three groups. Among 18 patients with markedly heterogeneous emphysema the proportion of men was higher (Table 1)than in the other two groups.

Baseline lung functional variables in percent of their predicted value were not different among the three groups and showed severe airflow obstruction and pulmonary hyperinflation in all patients. Forced expiratory volume in 1 second, forced vital capacity, and vital capacity in absolute

Comment

This prospective follow-up study assessed the duration of benefit of bilateral LVRS in respect to differences in emphysema morphology. We previously showed short-term (ie, at 3 months) improvements of dyspnea, exercise performance, and lung function after bilateral thoracoscopic LVR operation in our study population [5]. We also found the most pronounced amelioration in patients with markedly heterogeneous emphysema, but there was clinically relevant improvement in patients with homogeneous or

Acknowledgements

Supported by grant no. 3200-043358;95.1 from the Swiss National Science Fund and by a grant from the Zürich Lung League.

References (24)

Cited by (63)

  • Clinical and Quality of Life Outcomes After Lung Volume Reduction Surgery

    2019, Annals of Thoracic Surgery
    Citation Excerpt :

    Whereas heterogeneous disease is associated with greater improvements after undergoing LVRS, our group and others have shown that select patients with homogeneous disease see sufficient benefit to justify the risk of undergoing the procedure.20,21 Hamacher and coworkers20 followed cohorts of LVRS patients with heterogeneous, intermediately heterogeneous, and homogeneous disease for 2 years, finding that both functional metrics and quality of life data for all 3 cohorts sustained marked lasting improvements for the duration of the study. Our study separated the cohort into patients with heterogeneous vs homogeneous disease and examined changes in traditional objective measures while also extending the analysis to include a variety of QOL surveys.

View all citing articles on Scopus

This article has been selected for the open discussion forum on the STS Web site: http://www.sts.org/section/atsdiscussion/

View full text