Objective Despite the supportive results of the randomised, controlled NETT trial, lung volume reduction surgery (LVRS) is still infrequently performed in the United Kingdom. We however, have persisted with video assisted thoracoscopic (VATS) LVRS and report the results of our first 200 operations.
Patients/methods Surgical candidates for LVRS were selected by a multidisciplinary team approach using radionuclide scintigraphy in all cases. After the initial 20 open cases we adopted policy of two stage bilateral VATS LVRS with the timing of the second operation determined by the patient. 160 patients have completed one-stage LVRS: median age 60 (39–73) years and 20 patients have completed two-stage bilateral LVRS: median age 59 (41–66) years. Data from a prospective database were analysed to assess the postoperative changes in pulmonary function and health status (SF 36 questionnaire) recorded at three, six and, twelve months and thence annually.
Results 30-day mortality was 6% and 25% required post-operative ventilation (9 of 50 for <24 h). Hospital stay was 14 (2–110) days. FEV1 in both groups showed significant continuous improved at the 3-month, 6-month and 1-year postoperative review (p≤0.035). Furthermore, significant improvements (p≤0.05) in SF 36 were seen across the seven domains assessed: Physical Functioning (up to 1 year), Social Functioning (up to 1 year), Role-Physical (up to 1 year), Role-Emotional (at 5 years), Mental Health (up to 1 year), Energy/Vitality (up to 1 year), and General Health (up to 1 year). There has however been a significant reduction in the domain of Bodily Pain up to 4 years post LVRS (p≤0.05). More lasting improvements are seen in two-stage bilateral group compared to the one-stage group.
Conclusion The use of a multidisciplinary team approach and a prolonged surgical strategy can achieve durable postoperative benefits from LVRS for up to 4 years with acceptable risk.