Long-term outcome of bilateral lung volume reduction in 250 consecutive patients with emphysema

J Thorac Cardiovasc Surg. 2003 Mar;125(3):513-25. doi: 10.1067/mtc.2003.147.


Objective: Numerous reports have confirmed the early benefits of lung volume reduction surgery for selected patients with emphysema. This report documents the long-term survival and functional results after lung volume reduction surgery.

Methods: Between January 1993 and June 2000, a total of 250 consecutive patients underwent bilateral lung volume reduction surgery through median sternotomy at our institution. All patients had disabling dyspnea, thoracic hyperinflation, and a heterogeneous pattern of emphysema with suitable target areas for resection. Preoperative pulmonary rehabilitation was required and post-rehabilitation data were used as the baseline for data analysis. Follow-up ranged from 1.8 to 9.1 years (median 4.4 years).

Results: Prolonged air leaks (>7 days) were the most common complication (45.2%, n = 113). Reexploration rates for air leak and bleeding were 3.2% (n = 8) and 1.2% (n = 3), respectively. Eighteen patients (7.2%) required reintubation and mechanical ventilation. The in-hospital mortality in this series was 4.8% (n = 12). The median length of hospitalization was 9 days (range 4-168 days). Kaplan-Meier survivals after lung volume reduction surgery were 93.6%, 84.4%, and 67.7% at 1, 3, and 5 years, respectively. Eighteen patients (7.2%) have subsequently undergone lung transplantation after a median interval of 4.3 years (range 2.1-6.4 years). Spirometric values, lung volumes, and gas exchange parameters improved after surgery. The forced expiratory volume in 1 second and the residual volume showed statistically significant improvements between preoperative values and each time point of follow-up. Health-related quality of life showed significant postoperative improvement and with time correlated well with the improvement in forced expiratory volume in 1 second.

Conclusions: Lung volume reduction surgery produces significant functional improvement for selected patients with emphysema. For most of these patients, benefits appear to last at least 5 years.

MeSH terms

  • Aged
  • Blood Gas Analysis
  • Dyspnea / etiology
  • Female
  • Follow-Up Studies
  • Forced Expiratory Volume
  • Hospital Mortality
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Morbidity
  • Pneumonectomy / adverse effects
  • Pneumonectomy / methods*
  • Postoperative Hemorrhage / etiology
  • Proportional Hazards Models
  • Pulmonary Emphysema / complications
  • Pulmonary Emphysema / diagnosis
  • Pulmonary Emphysema / mortality
  • Pulmonary Emphysema / surgery*
  • Pulmonary Gas Exchange
  • Quality of Life
  • Reoperation / statistics & numerical data
  • Residual Volume
  • Risk Factors
  • Spirometry
  • Survival Analysis
  • Time Factors
  • Total Lung Capacity
  • Treatment Outcome