Lung volume reduction surgery
Lung volume reduction surgery (LVRS) is an emerging promising palliative treatment option for select patients with severe, debilitating pulmonary emphysema. It usually involves bilateral wedge resection of 20-30% of the most diseased lung through a median sternotomy. It has been proposed that LVRS reduces size mismatching between the hyperinflated lungs and chest cavity, which in turn restores outward circumferential pull on bronchioles (increasing elastic recoil) and improving expiratory airflow dynamics.
Pre-operative suitability is often assessed with a thoracic CT scan. This should also be complimented by relevant clinical factors (e.g presence of severe ischaemic heart disease etc) and respiratory function assessment.
Radiographic parameters used in assessing suitability
Factors that are generally thought to be favourable factors for LVRS include
- heterogenous pattern of emphysema - patients with large upper lobe lesions: respond better to LVRS than patients with small uniformly distributed disease 3.
- higher percentage of normal and mildly emphysematous lung at CT 6.
- younger age 8
Factors that are considered relative contraindications to LVRS include
- clinically significant bronchiectasis 7
- presence of pleural disease 7
- presence of unsuspected interstitial disease 7
- presence of an increapulmonary mass or concerning nodule.
- presence of pulmonary hypertension 8
- presence of severe airways disease 8
- presence of a profound thoraic wall deformity such as a a severe kyphosis 8
- 1. Slone RM, Gierada DS. Radiology of pulmonary emphysema and lung volume reduction surgery. Semin. Thorac. Cardiovasc. Surg. 1996;8 (1): 61-82. Pubmed citation
- 2. Rogers RM, Coxson HO, Sciurba FC et-al. Preoperative severity of emphysema predictive of improvement after lung volume reduction surgery: use of CT morphometry. Chest. 2000;118 (5): 1240-7. Pubmed citation
- 3. Coxson HO, Whittall KP, Nakano Y et-al. Selection of patients for lung volume reduction surgery using a power law analysis of the computed tomographic scan. Thorax. 2003;58 (6): 510-4. Free text at pubmed - Pubmed citation
- 4. Slone RM, Pilgram TK, Gierada DS et-al. Lung volume reduction surgery: comparison of preoperative radiologic features and clinical outcome. Radiology. 1997;204 (3): 685-93. Pubmed citation
- 5. Gierada DS, Yusen RD, Villanueva IA et-al. Patient selection for lung volume reduction surgery: An objective model based on prior clinical decisions and quantitative CT analysis. Chest. 2000;117 (4): 991-8. Pubmed citation
- 6. Slone RM, Pilgram TK, Gierada DS et-al. Lung volume reduction surgery: comparison of preoperative radiologic features and clinical outcome. Radiology. 1997;204 (3): 685-93. Pubmed citation
- 7. Washko GR, Hoffman E, Reilly JJ. Radiographic evaluation of the potential lung volume reduction surgery candidate. Proc Am Thorac Soc. 2008;5 (4): 421-6. doi:10.1513/pats.200802-017ET - Free text at pubmed - Pubmed citation
- 8. Cleverley JR, Hansell DM. Imaging of patients with severe emphysema considered for lung volume reduction surgery. Br J Radiol. 1999;72 (855): 227-35. Br J Radiol (abstract) - Pubmed citation
- 9. Meyers BF, Patterson GA. Chronic obstructive pulmonary disease. 10: Bullectomy, lung volume reduction surgery, and transplantation for patients with chronic obstructive pulmonary disease. Thorax. 2003;58 (7): 634-8. doi:10.1136/thorax.58.7.634 - Free text at pubmed - Pubmed citation
- 10. McKenna RJ, Brenner M, Fischel RJ et-al. Patient selection criteria for lung volume reduction surgery. J. Thorac. Cardiovasc. Surg. 1998;114 (6): 957-64. Pubmed citation
- 11. Argenziano M, Moazami N, Thomashow B et-al. Extended indications for lung volume reduction surgery in advanced emphysema. Ann. Thorac. Surg. 1997;62 (6): 1588-97. Pubmed citation
- 12. Screaton NJ, Reynolds JH. Lung volume reduction surgery for emphysema: What the radiologist needs to know. Clinical radiology. 61 (3): 237-49. doi:10.1016/j.crad.2005.09.009 - Pubmed