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Elective Surgery for Giant Bullous Emphysema^*

A 5-Year Clinical and Functional Follow-up

^* From the Sezione di Malattie dell’Apparato Respiratorio (Drs. Palla, Desideri, Bardi, Mazzantini, and Giuntini) and Chirurgia Toracica (Dr. Mussi), Dipartimento Cardio-Toracico, U.O. Fisiopatologia Respiratoria, Pisa, Italy; and Unità di Epidemiologia e Biostatistica (Dr. Rossi), Istituto di Fisiologia Clinica, CNR, Pisa, Italy.

Correspondence to: Antonio Palla, U.O. Fisiopatologia Respiratoria, Dipartimento Cardio-Toracico, Via Paradisa 2, Pisa 56100, Italy; e-mail: A.A.Palla{at}med.unipi.it

Background: So far, very few studies in the literature have reported data on the long-term follow-up of patients who have undergone surgery for giant bullous emphysema (GBE), and much still needs to be known on the late fate of these patients.

Aims: To evaluate patients who have undergone elective surgery due to GBE, early and late mortality following surgery, the early and late reappearance of bullae, and the early and late modifications of clinical and functional data.

Subjects and methods: Forty-one consecutive patients (36 men; mean [± SD] age, 48.4 ± 14.8 years) who underwent elective surgery for GBE were enrolled in a prospective study, and were studied both before and after undergoing bullectomy for a 5-year-follow-up period. Analyses were performed on the whole population and on two subgroups of patients who were divided on the basis of the absence of underlying diffuse emphysema (group A; n = 23) or the presence of underlying diffuse emphysema (group B; n = 18).

Results: The early mortality rate was 7.3% (within the first year), and the late mortality rate was 4.9% (overall mortality rate at 5 years, 12.2%; mortality rate in group B, 27.8%). Bullae did not reappear and residual bullae did not become enlarged in any patients at the site of the bullectomy. During the follow-up, the dyspnea score was reduced significantly soon after bullectomy and up to the fourth year of follow-up; intrathoracic gas volume also was reduced significantly (average, 0.7 L). The same was true for the FEV₁ percent predicted and the FEV₁/vital capacity ratio, which kept increasing until the second year; then, from the third year of follow-up these values were reduced, yet remained above the prebullectomy values until the fifth year of follow-up. When considered separately, the patients in group B appeared to be the most impaired, clinically and functionally (eg, FEV₁ showed a similar significant increase up to the second year in both groups after surgery, while a different mean annual decrease was appreciable from the second to the fifth year of follow-up: group A, 25 mL/year; group B, 83 mL/year. Furthermore, patients in group B were the only ones who contributed to the mortality rate, on the whole showing a behavior similar to that of patients who had undergone lung volume reduction surgery.

Conclusions: In patients with GBE who were enrolled in the study prospectively and were investigated yearly during a 5-year-follow-up period, elective surgery appears to have been fairly safe, and allowed clinical and functional improvement for at least 5 years. Better results may be expected in patients without underlying diffuse emphysema.

Key Words: COPD • pulmonary function test • thoracic surgery

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