Lung Volume Reduction Surgery is Safe and Leads to Functional Improvement in Patients Who Fail or Cannot Undergo Bronchoscopic Lung Volume Reduction.

Objective Bronchoscopic lung volume reduction (BLVR) has supplanted surgery in the treatment of patients with advanced emphysema, but not all patients qualify for it. Our study aims to investigate the outcomes of lung volume reduction surgery (LVRS) among patients who either failed BLVR or were not candidates for it. Methods We conducted a retrospective analysis of patients who underwent LVRS for upper lobe predominant emphysema in a single tertiary center between March 2018 and December 2022. The main outcomes measures were pre- and post-operative respiratory parameters, peri-operative morbidity, and mortality. Results A total of 67 LVRS were performed, of which 10 had failed prior valve placement. The median age was 69 and 35 (52%) were male. All procedures were performed thoracoscopically, with 36 patients (53.7%) undergoing bilateral LVRS. The median length of hospital stay was 7 days (IQR:6-11). Prolonged air leak (>7 days) occurred in 20 patients. There was one 90-day mortality from a nosocomial pneumonia (non-Covid related), and no further deaths at 12 months. The mean improvement in FEV1 was 10.07%, in DLCO 4.74%, and the mean decrease in RV 49.2% (p<0.001 for all). The modified Medical Research Council dyspnea scale improved by 1.84 points (p<0.001). Conclusion LVRS can be safely performed in patients who are not candidates for BLVR and those who fail it and leads to significant functional improvement. Long term follow-up is necessary to ensure the sustainability of LVRS benefits in this patient population.