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Journal Article Epublish 4 citations

PubMed: 42548516 DOI: 10.1016/j.chpulm.2025.100194

A Comprehensive Approach to Lung Volume Reduction Encompassing Surgical and Endobronchial Treatment of Severe Emphysema.

CHEST Pulm 3(4):100194

Authors: Wim Janssens, S Everaerts, N Filipow, C Vandervelde, J Coolen, H Geysen, A Blondeel, I Gyselinck, D Stylemans, I Niesten, F Janssens, S Bouneb, A Neyrinck, G Verleden, D Van Raemdonck, C Dooms, L Ceulemans

Affiliations

  • Departments of Respiratory Diseases, UZ Leuven, Belgium, CHROMETA Department, KU Leuven, Belgium.
  • Department of Thoracic Surgery, UZ Leuven, Belgium, CHROMETA Department, KU Leuven, Belgium.
  • Department of Radiology, UZ Leuven, Belgium.
  • Department of Rehabilitation Sciences, KU Leuven, Belgium.
  • Department of Anesthesiology, UZ Leuven, Belgium, Department of Cardiovascular Diseases, KU Leuven, Belgium.

Abstract

BACKGROUND

Randomized controlled trials with lung volume reduction surgery (LVRS) or endobronchial valves (EBVs) have shown clinically significant benefits for specific patients with emphysema.

RESEARCH QUESTION

What is the impact of a comprehensive lung volume reduction (LVR) program, with both LVRS and EBVs as treatment options, on patient selection and short- and long-term outcomes in real life?

STUDY DESIGN AND METHODS

This study summarizes the results of a prospective comprehensive LVR program in tertiary care, based on 5-year inclusions and follow-up over 1 to 3 years.

RESULTS

A total of 429 cases were discussed at a multidisciplinary emphysema board; of these, 131 (30%) were referred for LVRS, 73 (17%) were referred for EBV, 25 (6%) were referred for lung transplantation, and 200 (47%) were referred for usual care. A total of 38 (52%) of the EBV interventions were followed by a second to fourth intervention, including LVRS in 25 (34%). For LVRS first, 72 (55%) and 37 (38%) of patients had a single 1-stage bilateral or unilateral LVRS procedure, and 22 (17%) had a staged procedure. Clinically significant improvements between baseline and follow-up visits were obtained on all outcome dimensions in all LVRS and EBV groups for most of the visits. Responder rates varied between 50% and 80% at 3 months to 1 year and slowly declined in the second year. Transplant-free survival over 2.5 years, adjusted for age and BODE Index at baseline, was significantly better for the EBV intervention (hazard ratio, 0.14; 95% CI, 0.04-0.44) and borderline significant for LVRS (hazard ratio, 0.7; 95% CI, 0.45-1.2) compared with the nonintervention group.

INTERPRETATION

LVR programs should cover both surgical and bronchoscopic interventions to maximize eligibility and to improve outcome and prognosis of highly symptomatic patients with severe emphysema.

MeSH

Lung, Emphysema, Therapeutics