Emphysema is a form of chronic obstructive pulmonary disease (COPD) that is defined by abnormal and permanent enlargement of the airspaces distal to the terminal bronchioles and is associated with destruction of the alveolar walls. Emphysema causes dyspnea through airflow limitation, hyperinflation, and loss of gas exchanging surfaces in the lungs (also known as increased physiologic dead space).
Lung volume reduction surgery (LVRS, also called reduction pneumoplasty or bilateral pneumectomy) is a surgical technique that may be beneficial for some patients with advanced emphysema who have poor control of their disease despite maximal medical therapy. LVRS entails reducing the lung volume by wedge excision of emphysematous tissue .
The indications, contraindications, technique, and outcomes of LVRS will be reviewed here. The general management of chronic obstructive pulmonary disease, the evaluation and management of giant bullae, and the role of lung transplantation in end-stage emphysema are discussed separately. (See "Management of stable chronic obstructive pulmonary disease" and "Evaluation and medical management of giant bullae in COPD" and "Lung transplantation: General guidelines for recipient selection".)
RATIONALE OF LVRS
The mechanisms by which LVRS might provide benefit are not known with certainty. It has been suggested that LVRS reduces the size mismatching between the hyperinflated lungs and the chest cavity, thereby restoring the outward circumferential pull on the bronchioles (ie, increasing elastic recoil) and improving expiratory airflow [2-8]. As an example, in a study of 20 patients undergoing volume reduction surgery, 16 experienced an increase in elastic recoil . The patients with improved elastic recoil had a significantly greater increase in exercise capacity than the four without increased elastic recoil.
Other postulated mechanisms for clinical benefit include: