Lung volume reduction surgery

Lung volume reduction surgery (LVRS) has been widely used over the past 7 years to relieve symptoms and improve lung function in advanced emphysema. LVRS is the most recent and most successful in a long series of surgical approaches to emphysema. Although many patients benefit, LVRS carries an unavoidable risk of operative mortality, individual benefits among survivors vary widely, and improvements are only temporary. The monetary and human costs of this procedure, as well as the frustrating inability to reliably predict outcomes, have fed controversy over its proper role in emphysema treatment. This paper will briefly review some of the historical background leading to modern LVRS, the physiology of emphysema and mechanisms whereby the removal of lung can improve lung function, the methods to select patients and perform the operation, the results that can be expected, and the many questions that remain. The findings of the National Emphysema Treatment Trial, the largest randomized trial of LVRS by far, will be published soon. This review and those findings should provide clinicians with a sound basis for advising their patients.