Lung volume reduction reoperations

BACKGROUND: Optimal management of emphysematous patients who have lost the benefits achieved after lung volume reduction surgery is a clinical dilemma. We have hypothesized that in stringently selected instances, lung volume reduction reoperations might be considered as a salvage surgical treatment. We sought to analyze the results of a series of patients undergoing lung volume reduction reoperations after successful bilateral lung volume reduction surgery. METHODS: Between January 2000 and April 2006, 17 patients (mean age, 66 +/- 3 years) with radiologic evidence of distinct regional lung hyperinflation underwent lung volume reduction reoperations. Surgical procedures entailed completion lobectomy in 7 patients, nonanatomic resection of lung target areas were performed in 5 patients under general anesthesia with one-lung ventilation, and awake lung plication was performed in 5 patients under sole epidural anesthesia. Follow-up at 6 and 12 months was complete in all survivors. RESULTS: Mean operative time was 100 +/- 12 minutes. Two patients (11.7%) died perioperatively of adult respiratory distress syndrome. Hospital stay was 9 +/- 2 days. Significant improvements occurred for up to 12 months in forced expiratory volume in 1 second (FEV(1); p < 0.001), forced vital capacity (p < 0.002), residual volume (p < 0.001), 6-minute walk test (p < 0.001), and modified Medical Research Council dyspnea index (p < 0.001). At 6-months, improvements in FEV(1) were greater than 200 mL in 11 patients and correlated with the postoperative reduction in residual volume (r = -0.62, p = 0.01); baseline residual volume was inversely correlated with the degree of improvement in the dyspnea index (r = -0.54, p = 0.03). CONCLUSIONS: Lung volume reduction reoperations can offer significant clinical improvement to stringently selected patients who have lost the clinical benefit achieved after lung volume reduction surgery.