Chest
Volume 113, Issue 3, March 1998, Pages 652-659
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Clinical Investigations: Lung Volume Reduction Surgery
Rate of FEV1 Change Following Lung Volume Reduction Surgery

https://doi.org/10.1378/chest.113.3.652Get rights and content

Introduction

Lung volume reduction surgery (LVRS) improves pulmonary function and dyspnea symptoms acutely in selected patients with heterogeneous emphysema. Limited data are available regarding long-term function following LVRS. We analyzed short-term (<6 months) and long-term rate of change of pulmonary function in 376 patients who underwent unilateral or bilateral LVRS using thoracoscopic or median sternotomy, staple, laser, or combined techniques. We hypothesized that the long-term rate of deterioration in lung function would be dependent on the surgical procedure used and would be greatest in those with the largest short-term postoperative improvement.

Methods

Pulmonary function was assessed preoperatively and at repeated intervals following LVRS. The change in pulmonary function over time was assessed for each patient by determining the individual change in FEV1 using linear regression analysis short and long term. Overall rate of change in pulmonary function was calculated for the composite group of patients and subgrouped by operative procedure.

Results

Lung function appears to improve in the first few months following LVRS in most patients, maximizing at approximately 3 to 6 months and declining thereafter. The short-term incremental improvement following staple procedures is superior to improvements following laser procedures or unilateral surgery: FEV1 increase (mean±SD) of 0.39±0.03 L for bilateral staple, 0.25±0.03 L for unilateral staple, 0.10±0.03 L for unilateral laser, and 0.22±0.1 L for mixed unilateral staple/laser procedures. However, the long-term rate of decline in FEV1 was greatest for bilateral staple LVRS procedures as well: 0.255±0.057 L/yr for bilateral staple, 0.107±0.068 L/yr for unilateral staple, 0.074±0.034 L/yr for unilateral laser, and 0.209±0.12 L/yr for mixed staple laser procedures. There was a general correlation between the magnitude of short-term incremental improvement and the rate of deterioration in FEV1 (r=0.292, p=0.003).

Conclusions

While bilateral staple LVRS procedures lead to greater short-term improvement in FEV1, the more rapid rate of FEV1 decline in these patients and the general association between greater short-term incremental improvement and higher rates of deterioration raise questions regarding optimal long-term procedures. Further studies will be needed to answer these important questions.

Section snippets

Materials and Methods

All patients who underwent LVRS at Chapman Medical Center from May 1994 to July 1996 were included in this evaluation. Patients underwent baseline complete pulmonary function testing, including the following: spirometry, gas exchange measures (room air arterial blood gas measurement, diffusion of carbon monoxide), plethysmography, and gas dilution lung volumes (Table 1). Maximum inspiratory and expiratory flow volume curves and thoracic gas volume were measured in a plethysmograph

Composite Results in All Patients

A total of 376 patients underwent LVRS in this program during the analysis interval: 46 patients underwent unilateral laser LVRS; 111 had unilateral thoracoscopic staple LVRS; 184 had bilateral thoracoscopic staple LVRS; 21 had mixed thoracoscopic laser and staple procedures; and 14 had bilateral staple LVRS via median sternotomy. There were 15 perioperative deaths (mortality rate, 3.98%). In the overall group; follow-up pulmonary function results are available on 331 of the 361 surviving

Discussion

LVRS has been shown to be acutely effective in providing palliative improvement in pulmonary function in patients with heterogeneous emphysema in a number of studies.1, 2, 3, 4, 5, 6,9,12, 13, 14, 15, 16, 17 Postoperative pulmonary function appears to maximize at approximately 3 to 6 months following surgery. Limited available data suggest that benefit may be sustained for at least 1 to 2 years following surgery in most patients.4, 17 However, there is widely variable response to surgery as

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Supported in part by DOE grant DE-F603-91ER61227, ALA grant CI-030-N, CTRDRP No. 6RT-0158, and a Chapman Medical Center Research Grant.

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