Unilateral Lobe Resection by Video-Assisted Thoracoscopy Leads to the Most Optimal Functional Improvement in Severe Emphysema

Frank Beckers; Nadine Lange; Aris Koryllos; Fabrizio Picchioni; Wolfram Windisch; Erich Stoelben

doi:10.1055/s-0034-1395989

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 2016; 64(04): 336-342
DOI: 10.1055/s-0034-1395989

Original Thoracic

Georg Thieme Verlag KG Stuttgart · New York

Unilateral Lobe Resection by Video-Assisted Thoracoscopy Leads to the Most Optimal Functional Improvement in Severe Emphysema

Frank Beckers

¹Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Thoraxchrirugie der Privaten Universität Witten/Herdecke, Köln, Germany

,

Nadine Lange

¹Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Thoraxchrirugie der Privaten Universität Witten/Herdecke, Köln, Germany

,

Aris Koryllos

¹Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Thoraxchrirugie der Privaten Universität Witten/Herdecke, Köln, Germany

,

Fabrizio Picchioni

²Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Pneumologie und Beatmungsmedizin der Privaten Universität Witten/Herdecke, Köln, Germany

,

Wolfram Windisch

²Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Pneumologie und Beatmungsmedizin der Privaten Universität Witten/Herdecke, Köln, Germany

,

Erich Stoelben

¹Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Thoraxchrirugie der Privaten Universität Witten/Herdecke, Köln, Germany

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Abstract

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Abstract

Background Lung volume reduction surgery (LVRS) is a well-established treatment option for pulmonary emphysema, but the most advantageous technical approach remains debatable.

Methods Short- and long-term outcomes were comparably assessed in pulmonary emphysema patients who underwent unilateral LVRS with either lobe or sublobe (segment or wedge) resection. Patients were consecutively enrolled in the study after careful conventional and computer-based definition of the target region.

Results A total of 36 patients with a mean age of 62.1 ± 8.9 years (range, 41–79 years) were recruited. Video-assisted thoracoscopy (VATS) was performed in 33 patients, while 3 patients with additional early-stage lung cancer received anterolateral thoracotomy. Surgery duration was longer for lobectomy (median 93 minutes, range 44–168 minutes) as compared with sublobe resection (median 52 minutes, range 25–131 minutes; p = 0.0007), but complication rates were similar. After 90 days postsurgery, mortality was zero and lung function improved to a similar degree in both the groups. After 1 year, total lung capacity (TLC) was still reduced by 17.2 ± 20.6% predicted as compared with the baseline values for lobe resection, while TLC was increased by 12.1 ± 14.5% predicted for sublobe resection. In addition, the 6-minute walking distance improved following LVRS, with slightly better results in lobe resection patients.

Conclusions By careful definition of the target region, unilateral VATS-LVRS with lobe resection in severely affected pulmonary emphysema patients is a safe procedure that is superior to unilateral sublobe VATS resection in terms of improving long-term 1-year lung hyperinflation. Therefore, unilateral VATS lobe resection is a promising treatment approach that should be further evaluated by randomized controlled trials.

Keywords

emphysema - bullae - lung benign lesion - congenital lesion - pulmonary function - surgery complication - surgery incisions - thoracoscopy - VATS

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References

References
1 Fishman A, Martinez F, Naunheim K , et al; National Emphysema Treatment Trial Research Group. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med 2003; 348 (21) 2059-2073
2 Naunheim KS, Wood DE, Mohsenifar Z , et al; National Emphysema Treatment Trial Research Group. Long-term follow-up of patients receiving lung-volume-reduction surgery versus medical therapy for severe emphysema by the National Emphysema Treatment Trial Research Group. Ann Thorac Surg 2006; 82 (2) 431-443
3 Criner GJ, Belt P, Sternberg AL , et al; National Emphysema Treatment Trial Research Group. Effects of lung volume reduction surgery on gas exchange and breathing pattern during maximum exercise. Chest 2009; 135 (5) 1268-1279
4 Cassart M, Hamacher J, Verbandt Y , et al. Effects of lung volume reduction surgery for emphysema on diaphragm dimensions and configuration. Am J Respir Crit Care Med 2001; 163 (5) 1171-1175
5 Brown CD, Fessler HE. Lung volume reduction surgery. COPD 2005; 2 (3) 363-375
6 Huang W, Wang WR, Deng B , et al. Several clinical interests regarding lung volume reduction surgery for severe emphysema: meta-analysis and systematic review of randomized controlled trials. J Cardiothorac Surg 2011; 6: 148
7 Ginsburg ME, Thomashow BM, Yip CK , et al. Lung volume reduction surgery using the NETT selection criteria. Ann Thorac Surg 2011; 91 (5) 1556-1560 , discussion 1561
8 DeCamp Jr MM, McKenna Jr RJ, Deschamps CC, Krasna MJ. Lung volume reduction surgery: technique, operative mortality, and morbidity. Proc Am Thorac Soc 2008; 5 (4) 442-446
9 Meyers BF, Sultan PK, Guthrie TJ , et al. Outcomes after unilateral lung volume reduction. Ann Thorac Surg 2008; 86 (1) 204-211 , discussion 211–212
10 Serna DL, Brenner M, Osann KE , et al. Survival after unilateral versus bilateral lung volume reduction surgery for emphysema. J Thorac Cardiovasc Surg 1999; 118 (6) 1101-1109
11 Kotloff RM, Tino G, Palevsky HI , et al. Comparison of short-term functional outcomes following unilateral and bilateral lung volume reduction surgery. Chest 1998; 113 (4) 890-895
12 Lowdermilk GA, Keenan RJ, Landreneau RJ , et al. Comparison of clinical results for unilateral and bilateral thoracoscopic lung volume reduction. Ann Thorac Surg 2000; 69 (6) 1670-1674
13 Boley TM, Reid AJ, Manning BT, Markwell SJ, Vassileva CM, Hazelrigg SR. Sternotomy or bilateral thoracoscopy: pain and postoperative complications after lung-volume reduction surgery. Eur J Cardiothorac Surg 2012; 41 (1) 14-18
14 Edwards JG, Duthie DJ, Waller DA. Lobar volume reduction surgery: a method of increasing the lung cancer resection rate in patients with emphysema. Thorax 2001; 56 (10) 791-795
15 Vaughan P, Oey I, Nakas A, Martin-Ucar A, Edwards J, Waller D. Is there a role for therapeutic lobectomy for emphysema?. Eur J Cardiothorac Surg 2007; 31 (3) 486-490 , discussion 490
16 Yacoub WN, Meyers BF. Surgical resection in combination with lung volume reduction surgery for stage I non-small cell lung cancer. Semin Thorac Cardiovasc Surg 2010; 22 (1) 38-43
17 Choong CK, Mahesh B, Patterson GA, Cooper JD. Concomitant lung cancer resection and lung volume reduction surgery. Thorac Surg Clin 2009; 19 (2) 209-216
18 Criée CP, Sorichter S, Smith HJ , et al; Working Group for Body Plethysmography of the German Society for Pneumology and Respiratory Care. Body plethysmography—its principles and clinical use. Respir Med 2011; 105 (7) 959-971
19 American Thoracic Society; American College of Chest Physicians. ATS/ACCP Statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 2003; 167 (2) 211-277
20 Balady GJ, Arena R, Sietsema K , et al; American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council on Peripheral Vascular Disease; Interdisciplinary Council on Quality of Care and Outcomes Research. Clinician's Guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. Circulation 2010; 122 (2) 191-225
21 Palange P, Carlone S, Forte S, Galassetti P, Serra P. Cardiopulmonary exercise testing in the evaluation of patients with ventilatory vs circulatory causes of reduced exercise tolerance. Chest 1994; 105 (4) 1122-1126
22 Tomaszek SC, Cassivi SD, Shen KR , et al. Clinical outcomes of video-assisted thoracoscopic lobectomy. Mayo Clin Proc 2009; 84 (6) 509-513
23 McKenna Jr RJ. New approaches to the minimally invasive treatment of lung cancer. Cancer J 2005; 11 (1) 73-76
24 Kuhnigk JM, Dicken V, Zidowitz S , et al. Informatics in radiology (infoRAD): new tools for computer assistance in thoracic CT. Part 1. Functional analysis of lungs, lung lobes, and bronchopulmonary segments. Radiographics 2005; 25 (2) 525-536
25 Hazelrigg SR, Landreneau RJ, Boley TM , et al. The effect of muscle-sparing versus standard posterolateral thoracotomy on pulmonary function, muscle strength, and postoperative pain. J Thorac Cardiovasc Surg 1991; 101 (3) 394-400 , discussion 400–401
26 Brenner M, Yusen R, McKenna Jr R , et al. Lung volume reduction surgery for emphysema. Chest 1996; 110 (1) 205-218
27 Criner GJ, Cordova F, Sternberg AL, Martinez FJ. The National Emphysema Treatment Trial (NETT) Part II: Lessons learned about lung volume reduction surgery. Am J Respir Crit Care Med 2011; 184 (8) 881-893
28 Choong CK, Meyers BF, Battafarano RJ , et al. Lung cancer resection combined with lung volume reduction in patients with severe emphysema. J Thorac Cardiovasc Surg 2004; 127 (5) 1323-1331
29 Imperatori A, Rotolo N, Gatti M , et al. Peri-operative complications of video-assisted thoracoscopic surgery (VATS). Int J Surg 2008; 6 (Suppl. 01) S78-S81
30 McKenna Jr RJ, Brenner M, Fischel RJ, Gelb AF. Should lung volume reduction for emphysema be unilateral or bilateral?. J Thorac Cardiovasc Surg 1996; 112 (5) 1331-1338 , discussion 1338–1339
31 Bingisser R, Zollinger A, Hauser M, Bloch KE, Russi EW, Weder W. Bilateral volume reduction surgery for diffuse pulmonary emphysema by video-assisted thoracoscopy. J Thorac Cardiovasc Surg 1996; 112 (4) 875-882
32 Oey IF, Morgan MD, Spyt TJ, Waller DA. Staged bilateral lung volume reduction surgery - the benefits of a patient-led strategy. Eur J Cardiothorac Surg 2010; 37 (4) 846-852