Die chirurgische Lungenvolumenreduktion – Alternative oder Ergänzung zur Lungentransplantation

Zusammenfassung

Die chirurgische Lungenvolumenreduktion (Lung Volume Reduction Surgery: LVRS) und die Lungentransplantation (LuTX) stellen etablierte Therapieoptionen für Patienten mit fortgeschrittenem Lungenemphysem dar. Diese Übersichtsarbeit analysiert beide Verfahren hinsichtlich Indikationen, chirurgischer Techniken, Ergebnisse und Komplikationen. Besonderes Augenmerk wird auf die kontrovers diskutierte sequenzielle Anwendung gelegt – LVRS als Überbrückung bis zur Transplantation. Die Evidenz zeigt, dass beide Verfahren bei sorgfältiger Patientenselektion signifikante Verbesserungen der Lungenfunktion, Lebensqualität und des Überlebens erzielen können. Trotz gewisser Überlappungen der Indikationsspektren qualifizieren sich die meisten Patienten aufgrund ihrer spezifischen Konstellation nur für eines der Verfahren. Neuere Forschungsergebnisse haben traditionelle Kontraindikationen wie pulmonale Hypertonie oder homogenes Emphysem relativiert und das Indikationsspektrum erweitert. Entgegen früherer Annahmen belegen aktuelle multizentrische Studien, dass eine vorherige LVRS keine negativen Auswirkungen auf die Ergebnisse einer nachfolgenden Transplantation hat, sofern minimalinvasive Operationstechniken und modernes perioperatives Management eingesetzt werden. Die LVRS kann die Notwendigkeit einer Transplantation hinauszögern – ein wesentlicher Vorteil angesichts der Organknappheit. Der Schlüssel zum Erfolg liegt in der interdisziplinären Evaluation und personalisierten Therapieplanung, wobei beide Verfahren als komplementäre, nicht konkurrierende Optionen verstanden werden sollten. Zukünftige Forschung sollte sich auf prädiktive Biomarker, optimales Timing und kombinierte patientenzentrierte Endpunkte konzentrieren.

Abstract

Lung volume reduction surgery (LVRS) and lung transplantation (LuTX) are established therapeutic options for patients with advanced pulmonary emphysema. This review analyses both procedures with respect to indications, surgical techniques, outcomes, and complications. Special attention is given to the controversial sequential application as a bridge to transplantation. Evidence shows that both procedures can significantly improve lung function, quality of life, and survival when patients are carefully selected. Despite some overlap in indication criteria, most patients qualify for only one of the procedures as based on their specific clinical constellation. Recent research has challenged traditional contraindications such as pulmonary hypertension or homogeneous emphysema, and consequently, the indication spectrum for LVRS has been expanded. Contrary to earlier assumptions, current multicentre studies demonstrate that prior LVRS has no negative impact on subsequent transplantation outcomes, provided minimally invasive surgical techniques and modern perioperative management are employed. LVRS can delay the need for transplantation, which is a significant advantage given the shortage of donor organs. The key to success lies in interdisciplinary evaluation and personalized treatment planning. Both procedures should be understood as complementary rather than competing options. Future research should focus on predictive biomarkers, optimal timing, and combined patient-centred endpoints.

Schlüsselwörter

Emphysem - COPD - Lungenvolumenreduktion - Lungentransplantation - LVRS

Keywords

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

Publication History

Received: 26 March 2025

Accepted: 03 April 2025

Article published online:
24 April 2025

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