Uniportal thoracoscopic lung volume reduction surgery using enhanced recovery protocol for patients with diffuse emphysema : a midterm follow-up

Background: Lung volume reduction surgery (LVRS) is effective for selected patients with heterogeneous emphysema, however, reports about its effect on homogeneous cases is limited. The aim of this study is to investigate the efficacy of LVRS for patients with diffuse emphysema. Patients and methods: The data of 38 patients with bilateral diffuse emphysema who underwent uniportal thoracoscopic LVRS using enhanced recovery protocol was collected. The resected lung tissues were stained for pathological diagnosis. Their pulmonary function was evaluated by forced expiratory volume in 1 second (FEV1), St George’s Respiratory Questionnaire (SGRQ), modified Medical Research Council dyspnea scale (mMRC), and 6 minute walk distance (6-MWD). They were followed up online using smartphone after the operation. Results: All the patients survived after the operation. Five of them (5/38, 13.2%) with diffuse pulmonary fibrosis suffered from exacerbation of respiratory dysfunction during the perioperative period. The major surgery-related complications included 16 cases of air leakage (longer than 7 days) and 9 cases of nosocomial pneumonia. The other 33 (33/38, 86.8%) patients responded to bilateral LVRS, as indicated by the improved FEV1, SGRQ, and 6-MWD at 3, 6, 12, 18, 24 and 30 months after the operation (P < 0.05, respectively). On the 54-month follow up, a total of 20 responders (20/33, 60.6%) had been re-hospitalized asking for medical therapy. Conclusion: The efficacy of minimally invasive LVRS using enhanced recovery protocol on diffuse emphysema could last for at least 30 months. High-quality studies are still needed.