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PubMed · 9397040

Lung volume reduction surgery for emphysema.

G I Snell·P Solin·W Chin·M Rabinov·T J Williams·D S Esmore·J A Smith
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Abstract

OBJECTIVE: To report the results of lung volume reduction surgery (LVRS) for severe emphysema in Australia. SETTING: A tertiary teaching hospital. DESIGN: A prospective study of a consecutive case series. PARTICIPANTS: 20 patients (mean age, 56 years) with severe emphysema--mean forced expiratory volume in one second (FEV1), 0.72 L (28% of predicted) and severe gas trapping (mean residual volume, 286% of predicted). INTERVENTION: Bilateral apical LVRS was performed via a median sternotomy with a linear stapler; bovine pericardial strips were used to reinforce the staple line. RESULTS: There was a 95% survival, and a mean (range) inpatient stay of 17 (8-45) days. No complications occurred in nine patients; a further six patients had only minor complications. Five patients had major complications (sputum retention requiring reintubation, persistent air leak requiring reoperation, duodenal perforation, and epidural haemorrhage); one patient died from multiorgan failure at 28 days. Intercostal drainage was left in situ for a mean of eight days. The results of FEV1, Medical Research Council (MRC) Dyspnoea Score and six-minute walk test improved in more than 90% of patients. FEV1 improved an average of 0.35 L (54% over baseline) (P < 0.001). Mean MRC Dyspnoea Score decreased from 3.4 to 2.1 (P < 0.001). Mean distance for the six-minute walk test increased from 306 to 431 metres (P < 0.001). CONCLUSION: Our experience confirms that LVRS produces worthwhile early outcomes for a subgroup of patients with severe emphysema. The clinical, economic and ethical questions raised by this new therapy will need to be assessed.

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AdultAgedEmphysemaExercise TestFemaleForced Expiratory VolumeHumansLength of StayMaleMiddle AgedPatient SelectionPneumonectomyProspective StudiesResidual VolumeSeverity of Illness IndexSurvival AnalysisTreatment OutcomeJournal ArticleResearch Support, Non-U.S. Gov't

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G I Snell, P Solin, W Chin, M Rabinov, T J Williams, D S Esmore, J A Smith. 1997-11-17. Lung volume reduction surgery for emphysema.. https://doi.org/10.5694/j.1326-5377.1997.tb138873.x

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