Patient-directed Volume Reduction for Emphysema: Sequential Surgical and Endobronchial Techniques.

Background: Lung volume reduction (LVR) surgery has traditionally been performed as a 1-stage bilateral procedure or staged at a predetermined interval. However to maximize the overall benefit we have allowed the patient to determine the timing of further interventions and have added endobronchial LVR into the protocol. We have reviewed the long-term outcome.

The role of the multidisciplinary emphysema team meeting in the provision of lung volume reduction.

Despite a positive result in favour of lung volume reduction surgery (LVRS), from one of the largest randomized controlled trial in thoracic surgery, the identification of poor outcome in certain high-risk groups has resulted in a worldwide decrease in its utilization. Patient selection is the key to successful lung volume reduction which, with the advent of a range of less invasive techniques, has become more complex. The greater variety of potential therapeutic options will inevitably lead to debate amongst treating clinicians.

Hybrid bilobectomy for treatment of an early-stage lung cancer in a patient with severe emphysema using the benefits of lung volume reduction.

Patients with resectable lung cancer and concomitant emphysema can fall outside the accepted guidelines for surgery. Lung volume reduction can improve their lung function but involves resecting an emphysematous lobe containing the tumour. Volume reduction can also be achieved by endobronchial one-way valve insertion, causing lobar collapse, but intact fissures are required.

Long-term survival and symptomatic relief in lower lobe lung volume reduction surgery.

Objectives: Lung volume reduction surgery (LVRS) has been demonstrated to provide symptomatic relief and improve lung function in patients with end-stage emphysema. The National Emphysema Treatment Trial specifically noted functional benefits in patients with predominantly upper lobe emphysema and demonstrated improvement in quality-of-life parameters, in patients with non-upper lobe emphysema and a low-baseline exercise capacity. We aimed to investigate whether physiological and health status benefits correlated with lower lobe LVRS.

Patient experience of lung volume reduction procedures for emphysema: a qualitative service improvement project.

The aim of this service improvement project was to gain understanding of the patient experience of lung volume reduction surgery (LVRS) and endobronchial valve (EBV) placement, from referral through to post-discharge care. Focus group interviews were carried out in two tertiary centres in London and Leicester, UK. Sixteen patients who had undergone lung volume reduction surgery (LVRS), endobronchial valve (EBV) placement, or both, were recruited.

Individualised risk in patients undergoing lung volume reduction surgery: the Glenfield BFG score.

Lung volume reduction surgery (LVRS) has been shown to be beneficial in patients with chronic obstructive pulmonary disease, but there is low uptake, partly due to perceived concerns of high operative mortality. We aimed to develop an individualised risk score following LVRS.This was a cohort study of patients undergoing LVRS.

The role of the emphysema multidisciplinary team in a successful lung volume reduction surgery programme†.

Objectives: Lung volume reduction surgery (LVRS) for advanced emphysema is well established, with strong evidence from the National Emphysema Treatment Trial. However, there is still reluctance to offer the procedure, and many have looked for alternative, unproven treatments. The multidisciplinary approach has been well established in treatment of lung cancer and, more recently, in coronary artery surgery.

Staged bilateral lung volume reduction surgery - the benefits of a patient-led strategy.

Objective: Lung volume reduction surgery (LVRS) is conventionally a one-staged bilateral operation. We hypothesised that a more conservative staged bilateral approach determined by the patient not the surgeon would reduce operative risk and prolong the overall benefit.

Methods: In a population of 114 consecutive patients who were identified as suitable for bilateral LVRS an initial cohort of 26 patients (15 male; 11 female, median age: 58 years) underwent one-staged bilateral surgery: 18 by median sternotomy and eight by video-assisted thoracoscopic surgery (VATS) (group OB).

Latissimus dorsi myoclonus after video assisted thoracoscopic lung volume reduction.

Myoclonus as a sequel to thoracotomy has been reported, and its treatment can be challenging to both the patient and the surgeon. We describe a 43-year-old patient with chest wall pain and latissimus dorsi muscle contractions (myoclonus) after video-assisted thoracoscopic lung volume reduction. His symptoms remained refractory to benzodiazepines, nerve blockage, and botulinum toxin injection due to either poor compliance or lack of response to therapy.

Staged lung volume reduction surgery--rationale and experience.

The current convention is for bilateral one-stage lung volume reduction surgery. Unilateral surgery results in a symptomatic improvement in most patients. A staged approach to the second lung may reduce the risk of surgery and lead to a slower decline in physiologic improvement.

A prospective analysis of the inter-relationship between lung volume reduction surgery and body mass index.

Objectives: LVRS is thought to result in significant improvements in BMI. Patients with a higher BMI at the time of diagnosis of COPD are known to have better survival, and those with a low BMI prior to LVRS have significantly worse perioperative morbidity. We aimed to assess the influence of BMI on the outcome of LVRS in our own experience.

The increase in body mass index observed after lung volume reduction may act as surrogate marker of improved health status.

Objective: To assess the effects of lung volume reduction surgery (LVRS) on body mass index (BMI).

Methods: Prospective data was collected on a series of 63 patients undergoing LVRS (bilateral in 22 patients, unilateral in 41 patients). Median age was 58 (41-70) years.

Pseudo tumors of the lung after lung volume reduction surgery.

We describe 2 patients who underwent lung volume reduction surgery, who postoperatively had computed tomographic scans that showed symptomatic mass lesions suggestive of malignancy and an inhaled foreign body. Investigations excluded these conditions with the remaining likely diagnosis of pseudotumor secondary to buttressing material. These potential sequelae of lung volume reduction surgery should be recognized in follow-up investigations.

The long-term health status improvements seen after lung volume reduction surgery.

Objectives: To correlate the long-term changes in respiratory physiology, body mass index (BMI) and health status after lung volume reduction surgery (LVRS).

Patients/methods: From 1995 to 2002 77 patients; 48 male: 29 female, median age 59 (41-72) years, have undergone LVRS (simultaneous bilateral in 27; staged bilateral in 3; unilateral in 47). FEV(1), total lung capacity (TLC), residual volume (RV) and RV/TLC ratio were measured preoperatively and at 3 months, 6 months, 1 year, 2 years, 3 years and 4 years post surgery.