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Ann Thorac Surg 2000;70:1765
© 2000 The Society of Thoracic Surgeons

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Correspondence

Indications for lung volume reduction surgery

^a 4747 Hogan Dr, Wilmington, DE 19808-1712, USA,

e-mail: dvpecora{at}dnamail.com

To the Editor

The article by Brenner and associates in the February issue of the Annals of Thoracic Surgery [1] appropriately directs attention to the current confusion over the indications for the surgical treatment of pulmonary emphysema. Efforts to shed light upon the subject are to be commended. However, until the results of controlled studies are known, one must rely upon past experience for guidance.

The authors found that volume of lung resected correlated with improvement bronchial flow patterns. However, there was not a corresponding improvement in long-term survival. Patients could experience improvement in air flow and die on schedule. They suggest that factors other than improvement in spirometric variables may determine optimal lung volume resection and long-term survival. They suggest future studies. Although I agree, I believe our accumulated experience is not without value. Let us review what we already have learned.

A large proportion of normal lung tissue can be resected without adversely affecting pulmonary function or hemodynamics [2, 3]. Our results have been confirmed by others. We have learned that bronchial diameter and air flow in the normal lung are functions of lung volume. When bronchi are collapsed, they may be caused to dilate by expanding the lung even when some elasticity is lost as in emphysema. Unless lung volume is severely reduced or increased, the vascular diameter and resistance to blood flow are not appreciably affected. The results of pulmonary resection were adversely affected by the presence of pulmonary hypertension (increased pulmonary vascular resistance) [4]. Although usually not homogeneous, emphysema usually destroys both respiratory and accompanying vascular structures.

I would like to suggest that lung reduction surgery should be reserved for patients whose functionless tissue is compressing relatively normal lung tissue. Patients who have increased pulmonary vascular resistance due to destruction of pulmonary vessels cannot be improved by resecting more functional tissue. In the future, all candidates for volume reduction operations should have a thorough evaluation of pulmonary hemodynamics.

References

1. Brenner M., McKenna R., Jr, Chen J.C., et al. Relationship between amount of lung resection and outcome after lung volume reduction surgery. Ann Thorac Surg 2000;69:388-393.[Abstract/Free Full Text]
2. Pecora D.V. Progressive changes in ventilation following pulmonary resection. Surg Gynecol Obstet 1956;103:455-458.[Medline]
3. Pecora D.V., Hohenberger M. The effect of postpneumonectomy distention on pulmonary compliance and vascular resistance. Am Surgeon 1960;45:797-801.
4. Pecora D.V. Evaluation of cardiovascular reserve in candidates for chest surgery. J Thorac Cardiovasc Surg 1962;44:60-66.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): David V. Pecora Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Pecora, D. V. Search for Related Content PubMed Articles by Pecora, D. V.