We hypothesized that dyspnea in patients with emphysema was related with hyperinflation by highly destructed part with excessive trapped air and poor perfusion which could be expressed as “air-oma”. Accordingly we selected patients for LVRS with functional imaging modalities (HRCT, perfusion scan, dynamic MRI etc.)as well as functional examinations. We report early and long-term results of LVRS for consecutive 31 patients.
Between October 1995 and June 2003 we selected 31 patients who felt severe dyspnea during walk. Their characteristics and mean values in function testing were as follows; a mean age of 68 yr (range 52 - 80), BMI of 18 Kg/m2 (15-23), %FEV1 of 27% (11- 46), %RV of 263 % (178-385), and 6 MWD of 287m (75 –450). We decided airoma in the upper lobes of 12 patients, in the lower lobes of 12 patients, in both lobes of 6 patients, and in the middle lobe of 1 patient, and resected these by bilateral procedure in 17 patients, and by unilateral procedure in others. All patients were followed ranging from 1.8 to 9.5 years (median 6.5 yrs).
There was no in-hospital mortality. Two patients underwent reexploration for air leak, and two patients needed mechanical ventilation for a few months one month after LVRS. All patients except one reported decrease in dyspnea, and were satisfied with surgery. Eleven patients out of 22 patients who underwent LVRS by Dec 1999 survived more than 5 years. The Kaplan-Meier survival after LVRS were 96.8%, 93.6%, 90.1%, 72.1%, 49.3% at 1,2,3,4,and 5 years, respectively. There were no difference between survival of patients with upper lobe airoma and those with lower lobe airoma.
Lung volume reduction surgery for patient with emphysema selected by functional imaging modalities produces symptomatic improvement in early-term, and better survival at least 3 years.
Lung volume reduction surgery is a good and promising palliative treatment for patients with advanced emphysema wherever the target area, or airoma, is located.
Koji Chihara, None.