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J Thorac Cardiovasc Surg 1999;118:1101-1109
© 1999 Mosby, Inc.

GENERAL THORACIC SURGERY

SURVIVAL AFTER UNILATERAL VERSUS BILATERAL LUNG VOLUME REDUCTION SURGERY FOR EMPHYSEMA

From Divisions of Pulmonary Medicine, Cardiothoracic Surgery, and Beckman Laser Institute,^a and UC Irvine Medical Center, Orange, and Chapman Lung Center,^b Orange and Lakewood Regional Medical Center,^c Lakewood, Calif.

Address for reprints: Matt Brenner, MD, Pulmonary and Critical Care Medicine Division, UC Irvine Medical Center, Orange, CA 92668 (E-mail: mbrenner{at}bli.uci.edu ).

Objective: Bilateral staple lung volume reduction surgery (LVRS) immediately improves pulmonary function and dyspnea symptoms in patients with advanced heterogeneous emphysema to a greater degree than do unilateral procedures. However, the long-term outcome after these surgical procedures needs to be critically evaluated. We compare 2-year survival of patients who underwent unilateral versus bilateral video-assisted LVRS in a large cohort treated by a single surgical group.
Methods: The cases of all 260 patients who underwent video-assisted thoracoscopic stapled LVRS from April 1994 to March 1996 were analyzed to compare results after unilateral versus bilateral procedures. Overall survival was calculated by Kaplan-Meier methods; Cox proportional hazard methods were used to adjust for patient heterogeneity and baseline differences between groups.
Results: Overall survival at 2 years was 86.4% (95% CI 80.9%-91.8%) after bilateral LVRS versus 72.6% (95% CI 64.2%-81.2%) after unilateral LVRS (P = .001 for overall survival comparison). Improved survival after bilateral LVRS was seen among high- and low-risk subgroups as well. Average follow-up time was 28.5 months (range, 6 days to 46.6 months) for the bilateral LVRS group and 29.3 months (range, 6 days to 45.0 months) for the unilateral LVRS patients.
Conclusions: Comparison of unilateral versus bilateral thoracoscopic LVRS procedures for the treatment of emphysema reveals that bilateral LVRS by video-assisted thoracoscopy resulted in better overall survival at 2-year follow-up than did unilateral LVRS. This survival study, together with other studies demonstrating improved lung function after bilateral LVRS, suggests that bilateral surgery appears to be the procedure of choice for patients undergoing LVRS for most eligible patients with severe heterogeneous emphysema.

Supported in part by DOE Grant DE-F603-91ER61227, ALA Grant CI-030-N, CTRDRP Grant 6RT-0158, ACS Faculty Grant.

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