[Surgery for volume reduction in chronic pulmonary obstructive disease].

Pulmonary emphysema is an insidious disease and severe symptoms may not develop for many years. Most patients die within two years after medical treatment has became ineffective. In 1993, J. Cooper successfully revitalized lung volume reduction surgery (LVRS), the most effective emphysema treatment after lung transplantation. Distinct from Brantigan's approach, Cooper performed a simultaneous bilateral procedure through a median sternotomy. In our experience, we perform a unilateral lung volume reduction through an anterior thoracotomy. The sustained beneficial effects for up to 24 months with unilateral LVRS and the preservation of the contralateral side for future interventions if required, renders unilateral LVRS an attractive concept in this difficult palliative situation. Although several large series reported significant improvement in the short and intermediate term, controversy remains regarding the long term clinical benefit, morbidity and mortality of this procedure. A long term randomized trial comparing LVRS with ongoing medical management, the National Emphysema Treatment Trial (NETT), was conceived. The NETT results, suggest that surgery increases the chance of improved exercise capacity, reduce the risk of death among patients with upper-lobe emphysema and low exercise capacity, increase the risk among patients with non-upperlobe emphysema and high exercise capacity, and have little effect on the risk of death in the other patients.