Lung Volume Reduction Surgery for Emphysema

Lung Volume Reduction Surgery for Emphysema
Lung Biology in Health and Disease Volume 184 Clinical Tuberculosis 3rd Edition
Edited by H.E.Fessler, J.J.Reilly Jr, D.J.Sugarbaker
Published by Marcel Deckker Incs
Pages: 507. Price: £105.50, \#8364;156.99. ISBN 0-8247-0897-0

Lung volume reduction surgery (LVRS(, reintroduced by Joel Cooper in 1995, has become an important therapeutic option for patients suffering from severe pulmonary emphysema, particularly in an age group where lung transplantation is no longer an alternative.

In this 184th volume of the well known Deccker series, established a quarter of a century ago, experts in the field of chronic obstructive pulmonary disease (COPD( and thoracic surgery present an update overview on end-stage COPD, particularly on LVRS and the interface of LVRS and lung transplantation.

Roughly one-quarter of the books content is dedicated to nonsurgical aspects of emphysema, i.e. its pathology, the physiology of airflow limitation, the epidemiology of COPD and the medical treatment of this devastating condition, namely pharmacotherapy and pulmonary rehabilitation. This introductory part is followed by a chapter on patients' evaluation and selection, including the role of computed tomography and perfusion scintigraphy.

Aspects, such as bilateral versus unilateral LVRS, median sternotomy versus video-assisted thoracoscopy, anaesthetic considerations, perioperative complications and their management, are soundly described and provide an equilibrate overview on the pertinent literature. A particularly interesting chapter deals with the potential mechanisms explaining the striking functional results, which may be observed after LVRS in appropriately selected patients. A decent summary is presented on the short- and long- term results of LVRS. The book ends with a chapter presenting the results of the first large controlled prospective study on LVRS, the National Emphysema Treatment Trial (NETT(. The results of this trial have a major impact on the practice of LVRS in the USA and other parts of the world.

However, I miss in this volume a good overview on past attempts to improve the function of patients with emphysema by mechanical means, particularly a history of LVRS. As usual, such a book is not addressing readers who are personally active in research in this interesting field. They are likely to find their own contributions cited in the adequate context. However, this book is a worthy purchase for any pulmonary physician who cares for patients with severe COPD. It is also recommended as an add-on to the library of a hospital's pulmonary department, who, are not by now, regular subscribers of the Deckker's pulmonary monographs.