12. tbl. 97. árg. 2011

Lung volume reduction surgery for severe pulmonary emphysema in Iceland

Árangur lungnasmækkunaraðgerða við langvinnri lungnaþembu á Íslandi

Introduction: Lung volume reduction surgery (LVRS) can benefit patients with severe emphysema. The aim of this study was to evaluate the outcome of LVRS performed in Iceland.

Materials and methods: A prospective study of 16 consecutive patients who underwent bilateral LVRS through median sternotomy between January 1996 and December 2008. All patients had disabling dyspnea, lung hyperinflation, and emphysema with upper lobe predominance. Preoperatively all patients underwent pulmonary rehabilitation. Spirometry, lung volumes, arterial blood gases and exercise capacity were measured before and after surgery. Mean follow-up time was 8.7 years.

Results: Mean age was 59.2 ± 5.9 years. All patients had a history of heavy smoking. There was no perioperative mortality and survival was 100%, 93%, and 63% at 1, 5, and 10 years, respectively. The forced expiratory volume in 1 second (FEV1) and the forced vital capacity (FVC) improved significantly after surgery by 35% (p<0.001) and 14% (p<0.05), respectively. The total lung capacity, residual volume and partial pressure of CO2 also showed statistically significant improvements but exercise capacity, O2 consumption and diffusing capacity of the lung for CO did not change. Prolonged air leak (≥7 days) was the most common complication (n=7). Five patients required reoperation, most commonly for sternal dehiscence (n=4).

Conclusion: In this small prospective study, FEV1 and FVC increased and lung volumes and PaCO2 improved after LVRS. Long term survival was satisfactory although complications such as reoperations for sternal dehiscence were common and hospital stay therefore often prolonged.


 

Table I.  Postoperative complications for 16 consecutive patients that underwent lung volume reduction surgery at Landspitali during 1996-2008.  Patients can have more than one complication.

Complication Number
Prolonged air leak ≥7 days 7
Reoperation 5
   Sternal dehiscience 4
   Hemothorax 1
   Duodenal perforation 1
   Wound infection 1
Pneumonia 4


Table II.  Measurements of lung function, partial pressure of oxygen and carbon dioxide in arterial blood, oxygen consumption and exercise capacity before and after lung volume reduction surgery for 16 patients operated at Landspitali 1996-2008. Given are means with changes in percentages.

Source Preoperative Value Postoperative Value Change
FEV1 L (% of pred.) 0.97 (33) 1.31 (45) ↑ 35%**
FVC L (% of pred.) 2.9 (74) 3.3 (84) ↑ 14%*
FEV1/FVC ratio (%) 33 39 ↑ 18%*
TLC L (% of pred.) 7.8 (132) 7.2 (122) ↓ 8%*
RV L (% of pred.) 4.3 (199) 3.7 (171) ↓ 14%*
DLCO  mmol/kPa/min  (% of pred.) 3.2 (45) 3.0 (42) ↓ 7%
PaO2 (mm Hg) 71 70  
PaCO2 (mm Hg) 41 38**  
Maximal oxygen consumption (mL/min) 1031 1062  
Exercise capacity (W) 69 71  

FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; TLC, total lung capacity; RV, residual volume; DLCO, diffusion capacity for carbon monoxide; PaO2, partial pressure of oxygen in arterial blood; PaCO2 partial pressure of carbon dioxide in arterial blood.
*p<0.05
**p<0.001


Figure 1. Kaplan-Meier survival curve for 16 consecutive patients who underwent lung-volume reduction surgery in Iceland 1996-2008.  Survival at 1, 5 and 10 years was 100 %, 93% and63%, respectively.












Þetta vefsvæði byggir á Eplica