Chronic obstructive pulmonary disease • 10: Bullectomy, lung volume reduction surgery, and transplantation for patients with chronic obstructive pulmonary disease

• Published in: Thorax Vol. 58; no. 7; pp. 634 - 638
• Main Authors: Meyers, B F, Patterson, G A
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Thoracic Society 01-07-2003; BMJ; BMJ Publishing Group Ltd; BMJ Publishing Group LTD; BMJ Group
• Subjects: Airway management; Biological and medical sciences; bullectomy; Care and treatment; Chronic obstructive pulmonary disease; Chronic obstructive pulmonary disease, asthma; Emphysema; Emphysema, Pulmonary; Humans; Hyperinflation; Life expectancy; Lung diseases, Obstructive; Lung Transplantation - methods; lung volume reduction surgery; Lungs; Medical sciences; Mortality; Ostomy; Patient outcomes; Patient Selection; Patients; Physiology; Pneumology; Pneumonectomy - methods; Prognosis; Pulmonary Disease, Chronic Obstructive - surgery; Pulmonary Emphysema - surgery; Pulmonary hypertension; Rehabilitation; Review Series; Surgery; Survival Analysis; Transplantation; Transplants & implants; Treatment Outcome; United States; Human; Lung disease; Respiratory disease; Blebectomy; Lung; Exploration; Transplantation; Bullous emphysema; Homotransplantation; Chronic; Lung function; Treatment; Respiratory failure; Surgery; Bronchus disease; Complication; Obstructive pulmonary disease
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thorax.58.7.634

There are currently three surgical treatments for emphysema: bullectomy, lung transplantation, and lung volume reduction surgery (LVRS). Unfortunately, most emphysema patients are poor candidates for any surgical intervention. A meticulous selection process is favoured in which indications and contraindications are considered and the best solution is devised for each patient. Patients with giant bullae filling half the thoracic volume and compressing relatively normal adjacent parenchyma are offered bullectomy; those with hyperinflation, heterogeneous distribution of destruction, forced expiratory volume in 1 second (FEV1) >20%, and a normal carbon dioxide tension (Pco2) are offered LVRS; and patients with diffuse disease, lower FEV1, hypercapnia, and associated pulmonary hypertension are directed towards transplantation. Using these criteria, few patients are serious candidates for surgical procedures. Combinations of LVRS and lung transplantation, either simultaneously or sequentially, are possible but rarely necessary.