Evaluation of Lung Volume Reduction Surgery (LVRS) Based on Long-term Survival Rate Analysis

Abstract

Objective: Lung volume reduction surgery (LVRS) is an effective therapy for some patients with end-stage emphysema. In most cases, functional improvement is maximized during the first 6 months after surgery and decreases steadily afterwards. This study was aimed at gaining further understanding of the optimal candidates for LVRS and survival rates. Methods: 62 patients with LVRS were selected according to the inclusion criteria. Changes in lung function were evaluated by FEV1, VC, RV, TLC, DLCO, PaO₂, and PaCO₂, and survival rates were analyzed at 12, 24, 36, and 48 months. Patients with LVRS were divided into two groups - those surviving after 48 months and those not surviving after 48 months - and analyzed according to group. Results: The overall survival rate at 2 years and 4 years was 81.0 % and 67 %, respectively, with LVRS. VC, FEV1, TLC, DLCO, PaO₂, and PaCO₂ were potential factors leading to mortality according to univariate analysis. Multivariate analysis demonstrated that DLCO was the only independent factor that could predict the post-LVRS prognosis; the other factors failed as independent factors. Preoperatively, the FEV1 percentage predicted gave a good index for post-LVRS survival. Conclusions: Patients with higher preoperative FEV1 values had higher survival rates. These favorable long-term survival rates might justify LVRS for treating selected patients with severe emphysema. Additionally, DLCO turned out to be the only predictive factor for high mortality risk 4 years after LVRS. DLCO may thus be a very important marker in surgical planning.

Key words

LVRS - survival rate - selection

References

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