PDF herunterladen
Semin Respir Crit Care Med 2015; 36(04): 592-608
DOI: 10.1055/s-0035-1556064
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Surgical Approaches to Treating Emphysema: Lung Volume Reduction Surgery, Bullectomy, and Lung Transplantation

Nathaniel Marchetti
1   Department of Thoracic Medicine and Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania
,
Gerard J. Criner
1   Department of Thoracic Medicine and Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
03. August 2015 (online)

    Lizenzen und Reprints

Abstract

Chronic obstructive pulmonary disease (COPD) is a common and morbid progressive disease where treatment is focused on improving dyspnea, reducing exacerbations, attenuating comorbidities, and improving quality of life. Surgical therapy can be beneficial to a carefully selected subset of individuals and is the subject of this review. The National Emphysema Treatment Trial (NETT) has not only demonstrated the efficacy of lung volume reduction surgery (LVRS) but has also provided many lessons regarding advanced emphysema. NETT demonstrated that LVRS improves exercise performance, quality of life, and pulmonary function in those with upper lobe predominant emphysema in the setting of advanced disease. Those with upper lobe predominant emphysema and low exercise tolerance also had a survival advantage compared with maximal medical therapy. Careful patient selection is paramount to success, as there clearly are patients in whom LVRS increases mortality. Giant bullae are rare, but bullectomy has been demonstrated to improve dyspnea and lung function in cases where the bulla occupies at least one-third of the hemithorax and compresses some adjacent lung tissue. For patients with chronic respiratory failure due to COPD who have not improved despite maximal surgical and medical therapy, lung transplantation remains an option in those without significant comorbid conditions.

Keywords

emphysema - lung volume reduction surgery - lung transplantation - bullectomy - COPD
 

  • References

  • 1 Kochanek KD, Xu J, Murphy SL, Miniño AM, Kung HC. Deaths: preliminary data for 2009. Natl Vital Stat Rep 2011; 59 (4) 1-51
    PubMedGoogle Scholar
  • 2 Vestbo J, Hurd SS, Agusti AG , et al. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease, GOLD executive summary. Am J Respir Crit Care Med 2013; 187 (4) 347-365
    CrossrefPubMedGoogle Scholar
  • 3 Anthonisen NR, Skeans MA, Wise RA, Manfreda J, Kanner RE, Connett JE ; Lung Health Study Research Group. The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial. Ann Intern Med 2005; 142 (4) 233-239
    CrossrefPubMedGoogle Scholar
  • 4 Report of the Medical Research Council Working Party. Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Lancet 1981; 1 (8222) 681-686
    Google Scholar
  • 5 Nocturnal Oxygen Therapy Trial Group. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Ann Intern Med 1980; 93 (3) 391-398
    CrossrefPubMedGoogle Scholar
  • 6 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
    CrossrefPubMedGoogle Scholar
  • 7 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
    CrossrefPubMedGoogle Scholar
  • 8 Naef AP. History of emphysema surgery. Ann Thorac Surg 1997; 64 (5) 1506-1508
    CrossrefPubMedGoogle Scholar
  • 9 Winter B. Bilateral carotid body resection for asthma and emphysema. A new surgical approach without hypoventilation or baroreceptor dysfunction. Int Surg 1972; 57 (6) 458-466
    PubMedGoogle Scholar
  • 10 Severinghaus JW. Carotid body resection for COPD?. Chest 1989; 95 (5) 1128-1129
    CrossrefPubMedGoogle Scholar
  • 11 Whipp BJ, Ward SA. Physiologic changes following bilateral carotid-body resection in patients with chronic obstructive pulmonary disease. Chest 1992; 101 (3) 656-661
    CrossrefPubMedGoogle Scholar
  • 12 Lugliani R, Whipp BJ, Seard C, Wasserman K. Effect of bilateral carotid-body resection on ventilatory control at rest and during exercise in man. N Engl J Med 1971; 285 (20) 1105-1111
    CrossrefPubMedGoogle Scholar
  • 13 Brantigan OC, Mueller E, Kress MB. A surgical approach to pulmonary emphysema. Am Rev Respir Dis 1959; 80 (1, Part 2): 194-206
    PubMedGoogle Scholar
  • 14 Cooper JD, Trulock EP, Triantafillou AN , et al. Bilateral pneumectomy (volume reduction) for chronic obstructive pulmonary disease. J Thorac Cardiovasc Surg 1995; 109 (1) 106-116 , discussion 116–119
    CrossrefPubMedGoogle Scholar
  • 15 Cooper JD, Patterson GA, Sundaresan RS , et al. Results of 150 consecutive bilateral lung volume reduction procedures in patients with severe emphysema. J Thorac Cardiovasc Surg 1996; 112 (5) 1319-1329 , discussion 1329–1330
    CrossrefPubMedGoogle Scholar
  • 16 Criner GJ, Cordova FC, Furukawa S , et al. Prospective randomized trial comparing bilateral lung volume reduction surgery to pulmonary rehabilitation in severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999; 160 (6) 2018-2027
    CrossrefPubMedGoogle Scholar
  • 17 Geddes D, Davies M, Koyama H , et al. Effect of lung-volume-reduction surgery in patients with severe emphysema. N Engl J Med 2000; 343 (4) 239-245
    CrossrefPubMedGoogle Scholar
  • 18 Weinmann GG, Chiang YP, Sheingold S. The National Emphysema Treatment Trial (NETT): a study in agency collaboration. Proc Am Thorac Soc 2008; 5 (4) 381-384
    CrossrefPubMedGoogle Scholar
  • 19 The National Emphysema Treatment Trial Research Group. Rationale and design of The National Emphysema Treatment Trial: a prospective randomized trial of lung volume reduction surgery. Chest 1999; 116 (6) 1750-1761
    CrossrefPubMedGoogle Scholar
  • 21 National Emphysema Treatment Trial Research Group. Patients at high risk of death after lung-volume-reduction surgery. N Engl J Med 2001; 345 (15) 1075-1083
    CrossrefPubMedGoogle Scholar
  • 22 Naunheim KS, Wood DE, Krasna MJ , et al; National Emphysema Treatment Trial Research Group. Predictors of operative mortality and cardiopulmonary morbidity in the National Emphysema Treatment Trial. J Thorac Cardiovasc Surg 2006; 131 (1) 43-53
    CrossrefPubMedGoogle Scholar
  • 23 DeCamp MM, Blackstone EH, Naunheim KS , et al; NETT Research Group. Patient and surgical factors influencing air leak after lung volume reduction surgery: lessons learned from the National Emphysema Treatment Trial. Ann Thorac Surg 2006; 82 (1) 197-206 , discussion 206–207
    CrossrefPubMedGoogle Scholar
  • 24 McKenna Jr RJ, Benditt JO, DeCamp M , et al; National Emphysema Treatment Trial Research Group. Safety and efficacy of median sternotomy versus video-assisted thoracic surgery for lung volume reduction surgery. J Thorac Cardiovasc Surg 2004; 127 (5) 1350-1360
    CrossrefPubMedGoogle Scholar
  • 25 Chandra D, Lipson DA, Hoffman EA , et al; National Emphysema Treatment Trial Research Group. Perfusion scintigraphy and patient selection for lung volume reduction surgery. Am J Respir Crit Care Med 2010; 182 (7) 937-946
    CrossrefPubMedGoogle Scholar
  • 26 Washko GR, Martinez FJ, Hoffman EA , et al; National Emphysema Treatment Trial Research Group. Physiological and computed tomographic predictors of outcome from lung volume reduction surgery. Am J Respir Crit Care Med 2010; 181 (5) 494-500
    CrossrefPubMedGoogle Scholar
  • 27 Stoller JK, Gildea TR, Ries AL, Meli YM, Karafa MT ; National Emphysema Treatment Trial Research Group. Lung volume reduction surgery in patients with emphysema and alpha-1 antitrypsin deficiency. Ann Thorac Surg 2007; 83 (1) 241-251
    CrossrefPubMedGoogle Scholar
  • 28 Criner GJ, Scharf SM, Falk JA , et al; National Emphysema Treatment Trial Research Group. Effect of lung volume reduction surgery on resting pulmonary hemodynamics in severe emphysema. Am J Respir Crit Care Med 2007; 176 (3) 253-260
    CrossrefPubMedGoogle Scholar
  • 29 Washko GR, Fan VS, Ramsey SD , et al; National Emphysema Treatment Trial Research Group. The effect of lung volume reduction surgery on chronic obstructive pulmonary disease exacerbations. Am J Respir Crit Care Med 2008; 177 (2) 164-169
    CrossrefPubMedGoogle Scholar
  • 30 Snyder ML, Goss CH, Neradilek B , et al; National Emphysema Treatment Trial Research Group. Changes in arterial oxygenation and self-reported oxygen use after lung volume reduction surgery. Am J Respir Crit Care Med 2008; 178 (4) 339-345
    CrossrefPubMedGoogle Scholar
  • 31 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
    CrossrefPubMedGoogle Scholar
  • 32 O'Donnell DE, Revill SM, Webb KA. Dynamic hyperinflation and exercise intolerance in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001; 164 (5) 770-777
    CrossrefPubMedGoogle Scholar
  • 33 Lammi MR, Ciccolella D, Marchetti N, Kohler M, Criner GJ. Increased oxygen pulse after lung volume reduction surgery is associated with reduced dynamic hyperinflation. Eur Respir J 2012; 40 (4) 837-843
    CrossrefPubMedGoogle Scholar
  • 34 Martinez FJ, de Oca MM, Whyte RI, Stetz J, Gay SE, Celli BR. Lung-volume reduction improves dyspnea, dynamic hyperinflation, and respiratory muscle function. Am J Respir Crit Care Med 1997; 155 (6) 1984-1990
    CrossrefPubMedGoogle Scholar
  • 35 Dolmage TE, Avendano MA, Goldstein RS. Respiratory function during wakefulness and sleep among survivors of respiratory and non-respiratory poliomyelitis. Eur Respir J 1992; 5 (7) 864-870
    PubMedGoogle Scholar
  • 36 Lammi MR, Marchetti N, Criner GJ. Reduced dynamic hyperinflation after LVRS is associated with improved exercise tolerance. Respir Med 2014; 108 (10) 1491-1497
    CrossrefPubMedGoogle Scholar
  • 37 Barr RG, Bluemke DA, Ahmed FS , et al. Percent emphysema, airflow obstruction, and impaired left ventricular filling. N Engl J Med 2010; 362 (3) 217-227
    CrossrefPubMedGoogle Scholar
  • 38 Watz H, Waschki B, Meyer T , et al. Decreasing cardiac chamber sizes and associated heart dysfunction in COPD: role of hyperinflation. Chest 2010; 138 (1) 32-38
    CrossrefPubMedGoogle Scholar
  • 39 Jörgensen K, Müller MF, Nel J, Upton RN, Houltz E, Ricksten SE. Reduced intrathoracic blood volume and left and right ventricular dimensions in patients with severe emphysema: an MRI study. Chest 2007; 131 (4) 1050-1057
    CrossrefPubMedGoogle Scholar
  • 40 Jörgensen K, Houltz E, Westfelt U, Nilsson F, Scherstén H, Ricksten SE. Effects of lung volume reduction surgery on left ventricular diastolic filling and dimensions in patients with severe emphysema. Chest 2003; 124 (5) 1863-1870
    CrossrefPubMedGoogle Scholar
  • 41 Come CE, Divo MJ, San José Estépar R , et al; NETT Research Group. Lung deflation and oxygen pulse in COPD: results from the NETT randomized trial. Respir Med 2012; 106 (1) 109-119
    CrossrefPubMedGoogle Scholar
  • 42 Vestbo J, Prescott E, Almdal T , et al. Body mass, fat-free body mass, and prognosis in patients with chronic obstructive pulmonary disease from a random population sample: findings from the Copenhagen City Heart Study. Am J Respir Crit Care Med 2006; 173 (1) 79-83
    CrossrefPubMedGoogle Scholar
  • 43 Kim V, Kretschman DM, Sternberg AL, DeCamp Jr MM, Criner GJ ; National Emphysema Treatment Trial Research Group. Weight gain after lung reduction surgery is related to improved lung function and ventilatory efficiency. Am J Respir Crit Care Med 2012; 186 (11) 1109-1116
    CrossrefPubMedGoogle Scholar
  • 44 Mineo TC, Pompeo E, Mineo D, Ambrogi V, Ciarapica D, Polito A. Resting energy expenditure and metabolic changes after lung volume reduction surgery for emphysema. Ann Thorac Surg 2006; 82 (4) 1205-1211
    CrossrefPubMedGoogle Scholar
  • 45 Ramsey SD, Berry K, Etzioni R, Kaplan RM, Sullivan SD, Wood DE ; National Emphysema Treatment Trial Research Group. Cost effectiveness of lung-volume-reduction surgery for patients with severe emphysema. N Engl J Med 2003; 348 (21) 2092-2102
    CrossrefPubMedGoogle Scholar
  • 46 Ramsey SD, Shroyer AL, Sullivan SD, Wood DE. Updated evaluation of the cost-effectiveness of lung volume reduction surgery. Chest 2007; 131 (3) 823-832
    CrossrefPubMedGoogle Scholar
  • 47 Part B National Summary Data File. (Previously known as BESS(- Centers for Medicaid and Medicare Services 2014. Anonymous, Centers for Medicaid and Medicare Services. Available at: http://www.cms.gov/Research-Statistics-Data-and-Systems/Files-for-Order/NonIdentifiableDataFiles/PartBNationalSummaryDataFile.html . Accessed March 5, 2015
    PubMedGoogle Scholar
  • 48 Akuthota P, Litmanovich D, Zutler M , et al. An evidence-based estimate on the size of the potential patient pool for lung volume reduction surgery. Ann Thorac Surg 2012; 94 (1) 205-211
    CrossrefPubMedGoogle Scholar
  • 49 Criner GJ, Sternberg AL ; National Emphysema Treatment Trial Research Group. A clinician's guide to the use of lung volume reduction surgery. Proc Am Thorac Soc 2008; 5 (4) 461-467
    CrossrefPubMedGoogle Scholar
  • 50 Kim V, Criner GJ, Abdallah HY, Gaughan JP, Furukawa S, Solomides CC. Small airway morphometry and improvement in pulmonary function after lung volume reduction surgery. Am J Respir Crit Care Med 2005; 171 (1) 40-47
    CrossrefPubMedGoogle Scholar
  • 51 Hogg JC, Chu FS, Tan WC , et al. Survival after lung volume reduction in chronic obstructive pulmonary disease: insights from small airway pathology. Am J Respir Crit Care Med 2007; 176 (5) 454-459
    CrossrefPubMedGoogle Scholar
  • 52 Snider GL. Health-care technology assessment of surgical procedures: the case of reduction pneumoplasty for emphysema. Am J Respir Crit Care Med 1996; 153 (4, Pt 1): 1208-1213
    CrossrefPubMedGoogle Scholar
  • 53 Ting EY, Klopstock R, Lyons HA. Mechanical properties of pulmonary cysts and bullae. Am Rev Respir Dis 1963; 87: 538-544
    CrossrefPubMedGoogle Scholar
  • 54 Schipper PH, Meyers BF, Battafarano RJ, Guthrie TJ, Patterson GA, Cooper JD. Outcomes after resection of giant emphysematous bullae. Ann Thorac Surg 2004; 78 (3) 976-982 , discussion 976–982
    CrossrefPubMedGoogle Scholar
  • 55 Palla A, Desideri M, Rossi G , et al. Elective surgery for giant bullous emphysema: a 5-year clinical and functional follow-up. Chest 2005; 128 (4) 2043-2050
    CrossrefPubMedGoogle Scholar
  • 56 Krishnamohan P, Shen KR, Wigle DA , et al. Bullectomy for symptomatic or complicated giant lung bullae. Ann Thorac Surg 2014; 97 (2) 425-431
    CrossrefPubMedGoogle Scholar
  • 57 Pearson MG, Ogilvie C. Surgical treatment of emphysematous bullae: late outcome. Thorax 1983; 38 (2) 134-137
    CrossrefPubMedGoogle Scholar
  • 58 O'Donnell DE, Webb KA, Bertley JC, Chau LK, Conlan AA. Mechanisms of relief of exertional breathlessness following unilateral bullectomy and lung volume reduction surgery in emphysema. Chest 1996; 110 (1) 18-27
    CrossrefPubMedGoogle Scholar
  • 59 Travaline JM, Addonizio VP, Criner GJ. Effect of bullectomy on diaphragm strength. Am J Respir Crit Care Med 1995; 152 (5, Pt 1) 1697-1701
    CrossrefPubMedGoogle Scholar
  • 60 Marchetti N, Criner KT, Keresztury MF, Furukawa S, Criner GJ. The acute and chronic effects of bullectomy on cardiovascular function at rest and during exercise. J Thorac Cardiovasc Surg 2008; 135 (1) 205-206 , 206.e1
    CrossrefPubMedGoogle Scholar
  • 61 Hardy JD, Webb WR, Dalton Jr ML, Walker Jr GR. Lung Homotransplantation in Man. JAMA 1963; 186: 1065-1074
    CrossrefPubMedGoogle Scholar
  • 62 Yusen RD, Edwards LB, Kucheryavaya AY , et al; International Society for Heart and Lung Transplantation. The registry of the International Society for Heart and Lung Transplantation: thirty-first adult lung and heart-lung transplant report—2014; focus theme: retransplantation. J Heart Lung Transplant 2014; 33 (10) 1009-1024
    CrossrefPubMedGoogle Scholar
  • 63 Weill D, Benden C, Corris PA , et al. A consensus document for the selection of lung transplant candidates: 2014—an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2015; 34 (1) 1-15
    CrossrefPubMedGoogle Scholar
  • 64 Nishimura K, Izumi T, Tsukino M, Oga T. Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD. Chest 2002; 121 (5) 1434-1440
    CrossrefPubMedGoogle Scholar
  • 65 Pinto-Plata VM, Cote C, Cabral H, Taylor J, Celli BR. The 6-min walk distance: change over time and value as a predictor of survival in severe COPD. Eur Respir J 2004; 23 (1) 28-33
    CrossrefPubMedGoogle Scholar
  • 66 Schols AM, Slangen J, Volovics L, Wouters EF. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998; 157 (6, Pt 1): 1791-1797
    CrossrefPubMedGoogle Scholar
  • 67 Landbo C, Prescott E, Lange P, Vestbo J, Almdal TP. Prognostic value of nutritional status in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999; 160 (6) 1856-1861
    CrossrefPubMedGoogle Scholar
  • 68 Soler-Cataluña JJ, Martínez-García MA, Román Sánchez P, Salcedo E, Navarro M, Ochando R. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax 2005; 60 (11) 925-931
    CrossrefPubMedGoogle Scholar
  • 69 Celli BR, Cote CG, Marin JM , et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 2004; 350 (10) 1005-1012
    CrossrefPubMedGoogle Scholar
  • 70 Martinez FJ, Han MK, Andrei AC , et al; National Emphysema Treatment Trial Research Group. Longitudinal change in the BODE index predicts mortality in severe emphysema. Am J Respir Crit Care Med 2008; 178 (5) 491-499
    CrossrefPubMedGoogle Scholar
  • 71 Connors Jr AF, Dawson NV, Thomas C , et al. Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments). Am J Respir Crit Care Med 1996; 154 (4, Pt 1) 959-967
    CrossrefPubMedGoogle Scholar
  • 72 Soler-Cataluña JJ, Martínez-García MA, Sánchez LS, Tordera MP, Sánchez PR. Severe exacerbations and BODE index: two independent risk factors for death in male COPD patients. Respir Med 2009; 103 (5) 692-699
    CrossrefPubMedGoogle Scholar
  • 73 Weitzenblum E, Sautegeau A, Ehrhart M, Mammosser M, Hirth C, Roegel E. Long-term course of pulmonary arterial pressure in chronic obstructive pulmonary disease. Am Rev Respir Dis 1984; 130 (6) 993-998
    PubMedGoogle Scholar
  • 74 Burrows B, Kettel LJ, Niden AH, Rabinowitz M, Diener CF. Patterns of cardiovascular dysfunction in chronic obstructive lung disease. N Engl J Med 1972; 286 (17) 912-918
    CrossrefPubMedGoogle Scholar
  • 75 Anonymous. The International Society for Heart and Lung Transplantation Registries—Heart/Lung Registries; 2014. Available at: https://www.ishlt.org/registries/heartLungRegistry.asp . Accessed March 1, 2015
    PubMedGoogle Scholar
  • 76 Thabut G, Christie JD, Ravaud P , et al. Survival after bilateral versus single lung transplantation for patients with chronic obstructive pulmonary disease: a retrospective analysis of registry data. Lancet 2008; 371 (9614) 744-751
    CrossrefPubMedGoogle Scholar
  • 77 Munson JC, Christie JD, Halpern SD. The societal impact of single versus bilateral lung transplantation for chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2011; 184 (11) 1282-1288
    CrossrefPubMedGoogle Scholar
  • 78 Patel N, DeCamp M, Criner GJ. Lung transplantation and lung volume reduction surgery versus transplantation in chronic obstructive pulmonary disease. Proc Am Thorac Soc 2008; 5 (4) 447-453
    CrossrefPubMedGoogle Scholar
  • 79 Weinstein MS, Martin UJ, Crookshank AD , et al. Mortality and functional performance in severe emphysema after lung volume reduction or transplant. COPD 2007; 4 (1) 15-22
    CrossrefPubMedGoogle Scholar
  • 80 Nathan SD, Edwards LB, Barnett SD, Ahmad S, Burton NA. Outcomes of COPD lung transplant recipients after lung volume reduction surgery. Chest 2004; 126 (5) 1569-1574
    CrossrefPubMedGoogle Scholar
  • 81 Shigemura N, Gilbert S, Bhama JK , et al. Lung transplantation after lung volume reduction surgery. Transplantation 2013; 96 (4) 421-425
    CrossrefPubMedGoogle Scholar
  • 82 Backhus L, Sargent J, Cheng A, Zeliadt S, Wood D, Mulligan M. Outcomes in lung transplantation after previous lung volume reduction surgery in a contemporary cohort. J Thorac Cardiovasc Surg 2014; 147 (5) 1678-1683.e1
    CrossrefPubMedGoogle Scholar