After a decade of publications involving thousands of patients in cohort studies, hundreds of patients in small randomized controlled trials, and over a thousand patients in the NETT, many questions remain unanswered. Do the benefits of LVRS outweigh the harms? The NETT, the CLVR study, the OBEST, and the other published randomized controlled trials of LVRS have all demonstrated a low but significant early postoperative mortality (approximately 5%) from LVRS. The NETT has been the only published randomized controlled trial that assessed the impact of LVRS on mortality past 1 year after randomization, and a survival benefit from LVRS has not been demonstrated over a few years of follow-up. Although the NETT results suggest that a subgroup might improve its survival with LVRS, bias may have led to erroneous conclusions in this post hoc analysis.2Likewise, one cohort study3 with concomitant controls of patients with heterogeneous emphysema suggested that LVRS prolongs life after 2 to 4 years of follow-up, but the comparison of nonrandomized groups may have introduced significant bias. Overall, the impact of LVRS on survival seem clear: The surgery causes low but significant early mortality, and we lack the data to strongly support that it improves longevity.