Lung volume reduction surgery for chronic obstructive pulmonary disease (COPD)

In lung volume reduction surgery (LVRS), a large area of damaged lung is removed to allow the remaining lung tissue to expand when you breathe in. This surgery sometimes is done if you have severe chronic obstructive pulmonary disease (COPD) with severe emphysema.¹

The National Emphysema Treatment Trial has examined the results of LVRS. The results of this study report that people not considered good candidates for this surgery include people who have:²

• Severely impaired lung function as measured by breathing tests or a uniform pattern of emphysema throughout the lungs.
• Largely non-upper lung emphysema and who are able to exercise for a longer time than other people with COPD.
• Certain other serious medical problems.

For other people, LVRS may provide an increased ability to exercise and fewer symptoms compared to medical treatment. But it does not improve the survival rate compared to medical treatment, except in people who have emphysema mainly in the upper portion of the lungs and who are not able to exercise for long.³

Although selecting candidates for LVRS is subjective, criteria identifying good candidates for LVRS include people:⁴

• With severe emphysema that does not respond to medical therapy.
• Who are less than 75 to 80 years old.
• Who have not smoked for at least 4 months.
• With reasonable expectations of surgery results.
• With areas of the lung that can be targeted.
• With severe difficulty breathing as determined by breathing tests.

Decision to have the surgery

The decision to have this surgery is not an easy one. Not all patients who have emphysema or COPD will benefit from this surgery. Detailed testing is needed to determine if a person is likely to be helped by LVRS. Talk with your health professional about all of the treatment options available for COPD.

Citations

1. Global Initiative for Chronic Obstructive Lung Disease (GOLD) (2005). Executive summary (updated 2005). In Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Available online: http://www.goldcopd.com/GuidelinesResources.asp?I1=2&I2=0.

2. National Emphysema Treatment Trial Research Group (2003). A randomized trial comparing lung-volume reduction surgery with medical therapy for severe emphysema. New England Journal of Medicine, 348: 2059–2073.

3. Naunheim KS, et al. (2006). Long-term follow-up of patients receiving lung-volume-reduction surgery versus medical therapy for severe emphysema by the National Emphysema Treatment Trial Research Group. Annals of Thoracic Surgery, 82(2): 431–443.

4. Ciccone AM, et al. (2003). Long-term outcome of bilateral volume reduction in 250 consecutive patients with emphysema. Journal of Thoracic and Cardiovascular Surgery, 125(3): 513–525.