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* From the Thoracic Surgical Division, Department of Surgery, and Pulmonary Division, Department of Internal Medicine, University Hospital, Zürich, Switzerland.
Correspondence to: Walter Weder, MD, Thoracic Surgical Division, Department of Surgery, University Hospital, CH- 8091 Zürich, Switzerland; e-mail: walter.weder{at}chi.usz.ch
Study objective: To evaluate the activity and evolution in the field of lung volume reduction surgery (LVRS) performed at surgical centers in Europe.
Background: LVRS is a novel surgical therapy with the potential to improve lung function, exercise performance, and quality of life in selected patients suffering from severe pulmonary emphysema.
Methods: Questionnaire addressed to 75 European thoracic surgical centers presumed to perform LVRS, and review of the literature.
Results: Of 45 responding centers, 42 centers in 17
countries covering a population of 423 million reported performing
LVRS. Until the end of 1998, 1,120 patients were reported to have
undergone LVRS, corresponding to 2.6 patients/million inhabitants.
Thirty-one of 40 centers (78%) perform the operation bilaterally. Most
centers (83%) evaluate their activity prospectively. The average
perioperative mortality rate of 4.1% is moderate. The most commonly
utilized technique is video-assisted thoracoscopy, which is most
frequently performed bilaterally. Two thirds of the centers treat
patients with 
1-antitrypsin deficiency, and half of the
centers will consider patients with homogenous morphology of emphysema
on CT scan for LVRS. Half of the centers also perform lung
transplantation. The five largest centers have operated on 49% of all
LVRS patients assessed by this survey.
Conclusions: LVRS is performed at few thoracic surgical centers throughout Europe, with a large variation in the operative activity between different regions. Half of the centers also perform lung transplantation. Between 1995 and 1997, the number of LVRS procedures performed per year nearly tripled but has reached a plateau since then. As five centers perform nearly half the total number of operations, an optimal exchange of knowledge with smaller centers seems important.
Key Words: adult • epidemiology • lung diseases, obstructive • mortality • pulmonary emphysema • sternotomy • surgery • thoracoscopy
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