Lung volume reduction surgery - A survey on the European experience

Study objective: To evaluate the activity and evolution in the field of lung volume reduction surgery (LVRS) performed at surgical centers in Europe. Background: LVRS is a novel surgical therapy, with the potential to inprove lung function, exercise performance, and quality of life in selected patients suffering from severe pulmonary emphysema. Methods: Questionnaire addressed to 75 European thoracic surgical centers presumed to perform LVRS, and review of the literature. Results: Of 35 responding centers, 42 centers in 17 countries covering a population of 423 million reported performing LVRS. Until the end of 1998, 1,120 patients were reported to have undergone LVRS, corresponding to 2.6 patients/million inhabitants. Thirty-one of 40 centers (78%) perform the operation bilaterally. Most centers (83%) evaluate their activity prospectively. The average perioperative mortality rate of 4.1% is moderate, The most commonly utilized technique is video-assisted thoracoscopy, which is most frequently performed bilaterally. Two thirds of the centers treat patients with alpha(1)-antitrypsin deficiency, and half of the centers will consider patients with homogenous morphology of emphysema on CT scan for LVRS. Half of the centers also perform lung transplantation. The five largest centers have operated on 49% of all LVRS patients assessed by this survey. Conclusions: LVRS is performed at few thoracic surgical centers throughout Europe, with a large variation in the operative activity between different regions, Half of the centers also perform lung transplantation. Between 1995 and 1997, the number of LVRS procedures performed per year nearly tripled but has reached a plateau since then, hs five centers perform nearly half the total number of operations, an optimal exchange of knowledge with smaller centers seems important.