Bilateral surgical lung volume reduction for severe emphysema

Objective: To report preliminary results with a new surgical method of treating terminal emphysema by bilateral reduction of lung volume. Patients and methods: In a prospective study, the results obtained with the first 20 consecutive patients (mean FEV(1): 590 +/- 180 mi) who underwent operative reduction of lung volume were recorded. 19 of the 20 patients had required continuous oxygen supply. Results: The patients were extubated 8.5 +/- 6 h postoperatively; thoracic drainage was removed after 9 +/- 6 days. The degree of dyspnoea was decreased in all patients (3.5 +/- 0.5 vs 0.5 +/- 0.1). Significant reduction of overinflation occurred soon after the operation (residual volume 273 +/- 125 to 201 +/- 107% of normal; total capacity from 142 +/- 18 to 109 +/- 22 % of normal), as well as reduction in the degree of obstruction (FEV(1) from 18 +/- 6 to 24 +/- 7% of normal; for each, P < 0.05). One patient died 3 weeks postoperatively of Candida infection. Conclusion: The method looks promising for the treatment of selected patients and may thus provide an alternative to lung transplantation.