[Early and Long-term Results of Lung Volume Reduction Surgery for Severe Chronic Obstructive Pulmonary Disease Patient with Target Area Not Restricted in Upper Lobe].

Abstract

The basic patient selection criteria in lung volume reduction surgery (LVRS) is that the target area (TA) is located in the upper lobe since National Emphysema Treatment Trial (NETT). TA could be described as "airoma" (AO) with excess residual volume and poor perfusion, which compresses the adjacent lung and heart during expiration and causes dyspnea during walking. After Cooper's landmark report, we defined AO not only by functional static images such as high resolution computed tomography(HRCT) and perfusion scintigrams but also dynamic image of magnetic resonance imaging( MRI)during ventilation, and selected 36 patients with a mean age of 69 years, body mass index (BMI) of 18 kg/m2, modified Medical Research Council( mMRC) of 2.7, PaO2 of 68 mmHg, PaCO2 of 44 mmHg, forced expiratory volume in on second( FEV1)% of 29, % residual volume( RV) of 255, 6-min walk of 285 m, and VO2 max of 12.5 ml/kg/min from October 1995 to October 2015. AO was located in the upper lobe in 19 patients, in the lower lobe in 13 patients, and in the middle lobe or bi-lobes in 4 patients. Reduction of AO was performed by median sternotomy or video-assisted thoracic surgery (VATS). There was zero 90-day operative mortality and zero in-hospital mortality. Thirty-three of 36 patients were satisfied with decrease in dyspnea during walking, and three disappointed. The median follow-up for all patients was 4.5 years. The 1, 3, and 5-year survival rates in the upper lobe group were 100%, 94%, and 49%, respectively, compared with 92%, 77%, and 54%, respectively, in the lower lobe group. There was no difference in survival between the two groups. We believe that selected patients with lower lobe AO are candidates for LVRS, as well as upper lobe AO.