Lung volume reduction surgery

Lung volume reduction surgery, or LVRS, can improve the quality of life for certain COPD and emphysema patients. Parts of the lung that are particularly damaged by emphysema are removed, allowing the remaining, relatively good lung to expand and work more efficiently.

Conventional LVRS involves resection of the most severely affected areas of emphysematous, non-bullous lung (aim is for 20-30%). This is a surgical option involving a mini-thoracotomy for patients suffering end stage COPD due to underlying emphysema, and can improve lung elastic recoil as well as diaphragmatic function.

Increased mortality, contraindicating the procedure, is noted in patients that have both:

1. FEV₁ < 20%
2. DL_CO < 20% or diffusely distributed emphysema on a CT scan

The National Emphysema Treatment Trial^[1] was a large multicentre study (N = 1218) comparing LVRS with non-surgical treatment. Results suggested that:

1. There was no overall survival advantage in the LVRS group, except for mainly upper-lobe emphysema + poor exercise capacity, and
2. Significant improvements were seen in exercise capacity in the LVRS group.

Possible complications:^[2]

• Mortality at 90 days of 1.8% and survival at 3 and 5 years of 91.1% and 76% respectively.
• Prolonged air leak (mean duration post surgery until all chest tubes removed is 10.9 +/- 8.0 days)

In patients who have a predominantly upper lobe emphysema, lung volume reduction surgery could result in better health status and lung function, though it also increases the risk of early mortality and adverse events.^[3]

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