Ask An Expert: Lung Reduction Surgery

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Ask An Expert: Lung Reduction Surgery

Question:

I am a 44-year-old female with emphysema. My doctor wants to do a lung reduction surgery. Can you give me more information on this procedure?

Answer:

Lung volume reduction surgery (LVRS) is used to improve lung function in people with severe cases of emphysema. The procedure was pioneered a half-century ago, but fell out of use due to a high rate of complications. Recent improvements in surgical technique have led to renewed interest in using LVRS for people who don't respond to other treatments for emphysema.

In LVRS, a surgeon removes portions of the lung that have become most severely damaged by emphysema. Usually, about one-fifth to one-third of the total lung tissue is removed. This can be done using traditional surgery that involves making a large incision in the chest, or by minimally-invasive techniques that use telescopes, staple guns and lasers inserted through "keyholes" in the chest. No one is quite sure why LVRS works, but it appears that removing the most damaged lung tissue allows the remaining lungs to function more efficiently.

While the promise of improved lung function may sound appealing, it's important to recognize that LVRS involves high-risk surgery. A federally-funded study of lung reduction surgery [http://www.nhlbi.nih.gov/health/prof/lung/nett/lvrsweb.htm] found that only some people appear to reap the benefits:

• In certain patients, LVRS can reduce the likelihood of dying from emphysema, and can modestly increase exercise capacity. Ideal patients have emphysema mainly in the upper portions of their lungs, and have a reduced capacity for exercise (as measured by a standard treadmill or bicycle test).

• In contrast, LVRS decreases survival rates in patients with very severe emphysema. LVRS also appears to cause more harm than good in people with near-normal exercise capacity whose emphysema mainly affects the lower portions of their lungs.

• In certain other patients — for example, those with low exercise capacity and emphysema mainly affecting the lower portions of the lungs — LVRS can improve quality of life, but does not appear to lower the risk of dying from lung disease.

It's also important to realize that lung reduction surgery often provides only temporary benefits. Even people who benefit from the surgery may find that they are back to their pre-surgery condition within two to three years.

Before undergoing lung reduction surgery, you should have a thorough medical evaluation to make sure that you are an appropriate candidate. (Most types of medical insurance, including Medicare, won't even pay for your surgery unless you meet certain criteria.) Your doctor should also have a frank discussion with you about the risks and benefits of the surgery.

Last, there is evidence that your chance of having good results from LVRS may be improved by choosing a surgeon and a medical center that have a lot of experience in performing this procedure.

James S. Winshall, M.D., is an associate physician at Brigham and Women's Hospital. In addition to his role as senior editor at Harvard Health Publications, Dr. Winshall practices general internal medicine and is an assistant professor at Harvard Medical School.

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Last updated:	January 24, 2007