Lung Volume Reduction Surgery for Emphysema Treatment: State-of-the-Art and Perspectives

Lung volume reduction surgery (LVRS) has shown an improve for up to several years respiratory function, exercise capacity, and quality of life in selected patients with severe emphysema and low exercise capacity, particularly if upper-lobe predominance of disease is radiologically recognized. However, mortality and morbidity rates of LVRS have been not negligible leading to raising question as to the cost-effectiveness of the procedure and resulting in a progressive decline in its use although a considerable number of patients meet selection criteria and could potentially benefit of this treatment modality. In recent years, an active investigation aimed at developing less invasive strategies that might allow us to achieve long-term results as satisfactory as those of the standard LVRS method but with fewer adverse effects has been undertaken. So far, novel options including nonresectional surgical and endoscopic LVRS methods hold promise but results from large studies with long follow-up are awaited to help define the most effective interventional treatment options for patients with severe emphysema. In this literature review an analysis of the main issues related to LVRS including selection criteria, mechanisms of action, results of currently available surgical and endoscopic methods, and some potential future perspectives is provided