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
- DLCO >= 20% 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.
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ 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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/12759480
Drazen JM & Epstein AM Guidance concerning surgery for emphysema. N Engl J Med. 2003 May 22;348(21):2134-6 PMID: https://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/26670190 Free Article
- ↑ Garner JL, Shah PL. Lung volume reduction in pulmonary emphysema. Semin Respir Crit Care Med. 2020;41:874-85. PMID: https://pubmed.ncbi.nlm.nih.gov/32434233