lung volume reduction surgery; lung resection (LVRS)
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Introduction
Lung reduction surgery:
Indications
- symptomatic despite optimal medical management
- completion of pulmonary rehabilitation
- lung bullae present occupying > 1/3 of a hemithorax & compress adjacent lung on CT
- pulmonary emphysema
- upper lobe emphysema with low exercise capacity
- bilateral upper lobe emphysema on chest CT
- FEV1 < 45%, but > 20% of predicted[1]
- DLCO >= 20% of predicted
- post-bronchodilator total lung capacity > 150% of predicted & residual volume > 100% of predicted[1][6]
- PaCO2 <= 60 mm Hg & PaO2 >= 45 mm Hg[1] Other criteria:*
- maximal voluntary ventilation < 50% of predicted
- maximal oxygen uptake of < 15 mL/kg/min
- < 76 years of age
- pCO2 < 60 mm Hg[1][6]
- arterial pO2 >= 45 mm Hg on room air[1][6]
- absence of pulmonary hypertension
- no severe comorbidity
- not of smoking for 6 months
- completion of a pulmonary rehabilitation program
- FEV1 20-45% of predicted
* In carefully selected patients, 1 year mortality is 5-25%.
Benefits:
- make improve elastic recoil, diaphragm function & ventilation-perfusion mismatch
- may improve pulmonary function & gas exchange
- may improve exercise tolerance
Contraindications
- homogeneously distributed or diffuse pulmonary emphysema[1]
- FEV1 < 20% of predicted (relative)[1]
Diagnostic procedures
Procedure
- Pneumonectomy, lobectomy, segmental resection
- bronchoscopic lung volume reduction[5]*
* 1-way valves are inserted into selected bronchi in emphysematous parts of the lung. The valves induce atelectasis by excluding air, while allowing venting of expired CO2.
Complications
- operative & post-operative mortality[3] is high when
- platypnea-orthodeoxia in patients with patent foramen ovale[1]
More general terms
Additional terms
- lobectomy
- lung transplantation
- National Emphysema Treatment Trial
- segmentectomy; wedge resection of lung
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 16, 17, 18. American College of Physicians, Philadelphia 1998, 2006, 2012, 2015, 2018.
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 24
- ↑ 3.0 3.1 Journal Watch 21(20):159, 2001 National Emphysema Treatment Trial Research Group Patients at high risk of death after lung-volume-reduction surgery. N Engl J Med. 2001 Oct 11;345(15):1075-83. PMID: https://www.ncbi.nlm.nih.gov/pubmed/11596586
- ↑ Journal Watch 23(13):101, 2003 National Emphysema Treatment Trial Research Group, A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med. 2003 May 22;348(21):2059-73. PMID: https://www.ncbi.nlm.nih.gov/pubmed/12759479
National Emphysema Treatment Trial Research Group, Cost effectiveness of lung-volume-reduction surgery for patients with severe emphysema. N Engl J Med. 2003 May 22;348(21):2092-102. PMID: https://www.ncbi.nlm.nih.gov/pubmed/12759480
Drazen JM & Epstein AM Guidance concerning surgery for emphysema. N Engl J Med. 2003 May 22;348(21):2134-6 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12759481 - ↑ 5.0 5.1 Wan IY, Toma TP, Geddes DM, Snell G, Williams T, Venuta F, Yim AP. Bronchoscopic lung volume reduction for end-stage emphysema: report on the first 98 patients. Chest. 2006 Mar;129(3):518-26. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16537847
- ↑ 6.0 6.1 6.2 6.3 Berger RL, Decamp MM, Criner GJ, Celli BR. Lung volume reduction therapies for advanced emphysema: an update. Chest. 2010 Aug;138(2):407-17 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20682529
- ↑ Deslee G et al. Lung volume reduction coil treatment vs usual care in patients with severe emphysema: The REVOLENS randomized clinical trial. JAMA 2016 Jan 12; 315:175. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26757466
Sciurba FC et al. Bronchoscopic lung volume reduction in COPD: Lessons in implementing clinically based precision medicine. JAMA 2016 Jan 12; 315:139 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26757462 - ↑ Ginsburg ME, Thomashow BM, Bulman WA et al The safety, efficacy, and durability of lung-volume reduction surgery: A 10-year experience. J Thorac Cardiovasc Surg. 2016 Mar;151(3):717-724.e1. Epub 2015 Oct 30. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26670190 Free Article