Long-term Outcome of unilateral Versus Bilateral Reduction Pneumoplasty for Diffuse Emphysema

Background. It is believed that bilateral thoracoscopic reduction pneumoplasty (RP) yields superior results than unilateral RP. We sought to analyze the results of unilateral and bilateral RP performed with different indications based on clinical and radiologic morphology criteria. Methods. Amongst 536 patients evaluated for RP between October 1995 and October 2002, 142 (26%) patients underwent unilateral (73 patients) or bilateral RP (69 patients). Results. Follow-up averaged 40 months in the unilateral group and 45 months in the bilateral group. Acute (6 months) improvements in FEV1 were greater after bilateral than after unilateral RP (0.39L versus 0.27L, P=0.01). However, ΔFEV1 in patients with asymmetric emphysema was identical to that of patients undergoing a bilateral reduction (0.39L versus 0.39L, P=NS). Overall, sustained improvements in FEV1 occurred in most of operated patients for up to 36 months in the unilateral group and for up to 48 months in the bilateral group. Residual volume and dyspnea index were significantly improved for up to 48 months in both groups. Quality of life results assessed by the short-form-36-item questionnaire (SF-36) showed that both physical function and general health domains improved significantly and remained sustained in both study groups at 48 months. Five-year survival rates was 87% and 83%, in the unilateral and bilateral group, respectively (intergroup, P=NS). Conclusion. We conclude that meaningful improvements can occur for up to 48 months in dyspnea, respiratory function and quality of life measures in selected patients undergoing unilateral or bilateral RP selectively performed on the basis of clinical and morphologic criteria.