PURPOSE: Having demonstrated the comparative benefits of unilateral over bilateral video assisted thoracoscopic lung volume reduction surgery (VAT LVRS) it is now our policy to perform two-stage bilateral LVRS. The timing of the second operation is determined by the patients’ perception of their symptoms. We wished to determine whether this policy would result in a more sustained improvement in postoperative benefits.
METHODS: Since 1997 we have performed one-stage bilateral LVRS (Group-1) in 26 patients: median age 58 (41-72) years and two-stage LVRS (Group-2) in 6 patients: median age 60 (53-63) years. Median time between the two operations was 46 (14-55) months. Two further patients were turned down for their second stage procedure as their FEV1 and DLCO had fallen below selection criteria. The perioperative effects on pulmonary function and health status (Euroquol and SF-36) were recorded preoperatively and at 3, 6 and 12 months and thence annually for 5 years.
RESULTS: In both groups FEV1 significantly improved (27% in Group-1, 34% in Group-2) for 6 months but in Group-2 a second significant improvement (37% from preoperative values) was seen at 4 years. After the initial improvement the subsequent decline was −3 (+/−44) ml/year in Group-2 and −119 (+/−88) ml/year in Group-1 (p<0.002).In both groups TLC and RV were significantly improved for 2 years (TLC −15% in Group-1, −8% in Group-2; RV −22% in Group-1, −23% in Group-2), but in Group-2 further improvements (TLC −22%; RV −33% from preoperative values) were seen at 4 years. No significant improvements in Euroquol were seen in Group-1 whereas significant changes were seen from 2 to 4 years postoperatively in Group-2. There were significant changes up to 3 years in SF-36 scores in Group-1, up to 4 years in Group-2.
CONCLUSION: Early results suggest a more prolonged surgical strategy determined by the patient can lead to a more sustained benefit.
CLINICAL IMPLICATIONS: Patients need to be warned not to defer the second stage for too long as their physiology may have deteriorated to preclude further surgery.
DISCLOSURE: Inger Oey, None.