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* From the Pulmonary Division, Departments of Medicine (Dr. Gelb) and Radiology (Dr. Schein), Lakewood Regional Medical Center, University of California Los Angeles, Los Angeles, CA; the School of Medicine (Dr. Brenner), University of California, Irvine, Irvine, CA; the Faculty of Medicine (Dr. Zamel), University of Toronto, Toronto, Ontario, Canada; and the Department of Thoracic Surgery (Drs. McKenna and Fischel), Chapman Medical Center, Orange, CA.
Correspondence to: Arthur F. Gelb, MD, FCCP, 3650 E. South St, Suite 308, Lakewood, CA 90712; e-mail: afgelb{at}msn.com
Study objectives: Current data for patients > 2 years after lung volume reduction surgery (LVRS) for emphysema is limited. This prospective study evaluates pre-LVRS baseline data and provides long-term results in 26 patients.
Intervention: Bilateral targeted upper lobe stapled LVRS using video thoracoscopy was performed in 26 symptomatic patients (18 men) aged 67 ± 6 years (mean ± SD) with severe and heterogenous distribution of emphysema on lung CT. Lung function studies were measured before and up to 4 years after LVRS unless death intervened.
Results: No patients were lost to follow-up. Baseline
FEV1 was 0.7 ± 0.2 L, 29 ± 10% predicted; FVC,
2.1 ± 0.6 L, 58 ± 14% predicted (mean ± SD); maximum oxygen
consumption, 5.7 ± 3.8 mL/min/kg (normal, > 18 mL/min/kg);
dyspneic class 
3 (able to walk 
100 yards) and oxygen dependence
part- or full-time in 18 patients. Following LVRS, mortality due to
respiratory failure at 1, 2, 3, and 4 years was 4%, 19%, 31%, and
46%, respectively. At 1, 2, 3, and 4 years after LVRS, an increase
above baseline for FEV1 > 200 mL and/or FVC > 400 mL
was noted in 73%, 46%, 35%, and 27% of patients, respectively; a
decrease in dyspnea grade 1 in 88%, 69%, 46%, and 27% of
patients, respectively; and elimination of oxygen dependence in 78%,
50%, 33%, and 22% of patients, respectively. The mechanism
for expiratory airflow improvement was accounted for by the increase in
both lung elastic recoil and small airway intraluminal caliber and
reduction in hyperinflation. Only FVC and vital capacity (VC) of all
preoperative lung function studies could identify the 9 patients with
significant physiologic improvement at > 3 years after LVRS,
respectively, from 10 patients who responded 2 years and died
within 4 years (p < 0.01).
Conclusions: Bilateral LVRS provides clinical and physiologic improvement for > 3 years in 9 of 26 patients with emphysema primarily due to both increased lung elastic recoil and small airway caliber and decreased hyperinflation. The 9 patients had VC and FVC greater at baseline (p < 0.01) when compared to 10 short-term responders who died < 4 years after LVRS.
Key Words: emphysema • lung elastic recoil • lung function • lung volume reduction surgery • transdiaphragmatic pressures
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