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A Journal on Diseases of the Respiratory System
Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
REVIEWS ADVANCES IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
Minerva Pneumologica 2009 March;48(1):51-9
Indications for surgical intervention in COPD
Van Berkel V., Meyers B. F.
Division of Cardiothoracic Surgery, Washington University, St. Louis, MO, USA
Chronic obstructive pulmonary disease (COPD) is a progressive disease with substantial associated morbidity and mortality. While numerous surgical modalities have been tried as solutions to this debilitating disease, only three – bullectomy, lung volume reduction surgery (LVRS), and transplantation – have been demonstrated to have any benefit towards either survival or improvement in quality of life. These interventions are viable options in a select group of patients with severe, incapacitating emphysema. Only those patients that have failed to progress despite optimized medical therapy and a rigorous pulmonary rehabilitation regiment should be considered for operative planning. Pulmonary function tests, chest radiography, computed tomography, and nuclear ventilation-perfusion scans then further delineate those patients who are most likely to benefit from the operation, as well as determining which intervention is most likely to have a good outcome. The surgical options available to the patient depend upon the spectrum of the distribution of their disease – isolated bullae can be treated with bullectomy, heterogeneous emphysema lends itself to LVRS, while homogenous disease is best treated by lung transplantation. The ideal indicators for LVRS also include hyperinflation, a FEV1 greater that 20%, and a normal PaCO2. In contrast, patients with a low FEV1, hypercapnia, and associated pulmonary hypertension are directed towards transplantation. Using these criteria, there are few patients that are serious candidates for surgical intervention.