Lung-volume reduction surgery as an alternative or bridging procedure to lung transplantation

Ann Thorac Surg. 2006 Jul;82(1):208-13; discussion 213. doi: 10.1016/j.athoracsur.2006.02.004.


Background: In this study, we prospectively analyzed the functional outcome and the survival after lung-volume reduction surgery (LVRS) in patients with end-stage emphysema who were initially potential candidates for lung transplantation (LTX), and investigated the impact of LVRS on posttransplant course in patients who underwent LTX after LVRS.

Methods: Of the 216 patients who underwent LVRS between 1994 and 2005, 58 were potential candidates for LTX at the time of LVRS (age 65 years or younger, forced expiratory volume in 1 second 25% of predicted or less; LVRS/LTX group). Lung-volume reduction surgery was performed by means of video-assisted, bilateral stapled resection of target areas. During the same period, 31 patients underwent primary LTX for end-stage emphysema (LTX group). Spirometry, plethysmography, carbon monoxide diffusing capacity, 6-minute walking distance, and dyspnea score were assessed preoperatively and at predetermined times after operation. Survival analysis was performed by use of the Kaplan-Meier method.

Results: All the functional variables significantly improved after LVRS and peaked within the first year. Subjective improvement was observed for up to 5 years after LVRS, and 53% (31 of 58) of the patients were still alive and had not undergone transplantation after a median follow-up of 44 months. Fourteen percent (8 of 58) of the patients underwent secondary LTX because of progressive worsening of the respiratory function after a median bridging time between LVRS and LTX of 33 months. Postoperative recovery after transplantation and median survival time were comparable between the 8 patients of the LVRS/LTX group and the 31 patients of the LTX group (96.5 months versus 118.5 months, p = 0.9).

Conclusions: Lung-volume reduction surgery can significantly improve symptoms and lung function in selected patients who are initially potential candidates for LTX. Lung-volume reduction surgery can allow the postponement of LTX for up to 4 to 5 years and does not impair the chances for a subsequent successful LTX.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Carbon Monoxide / analysis
  • Dyspnea / etiology
  • Exercise Test
  • Female
  • Follow-Up Studies
  • Forced Expiratory Volume
  • Humans
  • Life Tables
  • Lung Transplantation*
  • Male
  • Middle Aged
  • Plethysmography
  • Pneumonectomy*
  • Prospective Studies
  • Pulmonary Emphysema / mortality
  • Pulmonary Emphysema / surgery*
  • Severity of Illness Index
  • Spirometry
  • Surgical Stapling
  • Survival Analysis
  • Thoracic Surgery, Video-Assisted
  • Treatment Outcome
  • Waiting Lists


  • Carbon Monoxide