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Ann Thorac Surg 1999;68:2026-2031
© 1999 The Society of Thoracic Surgeons
a Division of Cardiothoracic Surgery, Saint Louis University, St. Louis, Missouri, USA
b Division of Cardiothoracic Surgery, Southern Illinois University, Springfield, Illinois, USA
c Division of Cardiothoracic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
d Division of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
e Division of Cardiothoracic Surgery, Allegheny University, Pittsburgh, Pennsylvania, USA
f COR Specialty Associates of North Texas, Dallas, Texas, USA
Address reprint requests to Dr Naunheim, Department of Surgery, Saint Louis University Health Sciences Center, 3635 Vista Ave at Grand Blvd, PO Box 15250, St. Louis, MO 63110-0250
e-mail: naunheim{at}slu.edu
Presented at the Thirty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 25–27, 1999.
Abstract
Background. It has been suggested that bilateral thoracoscopic lung volume reduction (BTLVR) yields significantly better long-term survival than unilateral thoracoscopic lung volume reduction (UTLVR).
Methods. All perioperative data were collected at the time of the procedure. Follow-up data were obtained during office visits or by telephone.
Results. A total of 673 patients underwent thoracoscopic LVR: 343 had either simultaneous or staged BTLVR and 330, UTLVR. As of July 1998, follow-up was available on 667 (99%) of the 673 patients with a mean follow-up of 24.3 months. The patients in the BTLVR group were significantly younger (62.6 ± 8.0 years versus 65.4 ± 8.1 years; p < 0.0001), had a higher preoperative arterial oxygen tension (69.7 ± 12 mm Hg versus 65.3 ± 11 mm Hg; p < 0.0001), and had a superior preoperative 6-minute walk performance (279.9 ± 93.6 m [933 ± 312 feet] versus 244.5 ± 101.4 m [815 ± 338 feet] p < 0.0001). There was no difference in the operative mortality rate between the two groups (UTLVR, 5.1%, and BTLVR, 7%). Actuarial survival rates for the UTLVR group at 1 year, 2 years, and 3 years were 86%, 75%, and 69%, respectively versus 90%, 81%, and 74%, respectively, for the BTLVR group (p = not significant).
Conclusions. Contrary to previous reports, survival after BTLVR was not superior to that after UTLVR even though the former group appeared to have a lower risk preoperatively because of younger age, higher arterial oxygen tension, more advantageous anatomy, and better functional status. Despite thoracoscopic LVR, the actuarial mortality rate approached 30% at 3 years, and this calls into question whether this procedure offers any survival advantage to patients with end-stage emphysema.
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