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Ann Thorac Surg 1999;68:1792-1798
© 1999 The Society of Thoracic Surgeons

Original Articles

Two years’ outcome of lung volume reduction surgery in different morphologic emphysema types

Jürg Hamacher, MDa, Konrad E. Bloch, MDa, Uz Stammberger, MDb, Ralph A. Schmid, MDb, Irene Laube, MDa, Erich W. Russi, MDa, Walter Weder, MDb

a Pulmonary Division, Department of Internal Medicine, University Hospital, Zürich, Switzerland
b Division of Thoracic Surgery, Department of Surgery, University Hospital, Zürich, Switzerland

Address reprint requests to Dr Weder, Division of Thoracic Surgery, Department of Surgery, University Hospital, CH-8091 Zürich, Switzerland

Presented at the Thirty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 25–27, 1999.

Background. Lung volume reduction surgery (LVRS) improves dyspnea, pulmonary function, and quality of life in selected patients with severe emphysema. We investigated the role of emphysema morphology in 37 patients as an outcome predictor for up to 2 years after operation.

Methods. Patients selected for bilateral thoracoscopic LVRS were divided, according to a simplified emphysema morphology classification, into three groups (homogeneous, moderately heterogeneous, and markedly heterogeneous) based on a preoperative chest computed tomogram. Pulmonary function, walking distance, and dyspnea were assessed.

Results. Functional improvement after LVRS was best in markedly heterogeneous emphysema with an increase from preoperative forced expiratory volume in 1 second of 31% ± 2% (mean ± standard error of the mean) to 52% ± 4% of predicted postoperatively. It was significantly higher than in homogeneous emphysema (from 26% ± 1% to 38% ± 2% predicted) and in intermediately heterogeneous emphysema (from 29% ± 2% to 44% ± 45% predicted). At 24 months postoperatively, forced expiratory volume in 1 second and dyspnea score continued to be significantly better than preoperative levels in all three morphologic groups. The survival rate was highest in patients with markedly heterogeneous emphysema.

Conclusions. Functional and subjective improvements were maintained after LVRS for at least 24 months in patients with heterogeneous or homogeneous emphysema type.




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