Abstract
Introduction: LVR has shown to be most effective when targeting the most diseased tissue in heterogeneous emphysema. Segmental LVR reduces lower density upper lobe (UL) segments while preserving higher density UL segments. Lobar LVR reduces all segments of a lobe regardless of their disease state.
Objective: Does segmental LVR result in an improved heterogeneity between treated and preserved tissue as compared to lobar LVR?
Methods: Baseline CT scans from the STEP-UP RCT treatment arm were quantitatively assessed with VIDA. Patients (n=45) had segmental density heterogeneity of >15%. The upper lobe with greater fissure completeness was selected for a hypothetical unilateral lobar LVR comparison.
Results: Segmental LVR treated lower density/more diseased segments and preserved higher density/less diseased segments as compared to lobar LVR (p-value < 0.05).
Bilateral Segmental LVR | Unilateral Lobar LVR | Bilateral Lobar LVR | |
Segments | Mean Density (SD) | ||
Treated UL | 8.5% (1.8%) | 9.6% (2.3%) | 9.4% (1.9%) |
Preserved UL | 10.4% (2.2%) | 9.4% (1.9%) | None - all treated |
Preserved ML & LL | 14.2% (2.3%) | 14.2% (2.3%) | 14.2% (2.3%) |
ML= middle lobe (+ lingula); LL=lower lobe |
Conclusions: Segmental LVR with vapor improves targeting of most diseased tissue in heterogeneous emphysema. As a result, it may be more effective than Lobar LVR and allows for further reduction of UL segments when disease progresses compared to bilateral lobar LVR.
- Copyright ©the authors 2016