Lung Volume Reduction Surgery for Severe Emphysema

• What is lung volume reduction surgery?
• What conditions can be treated with lung volume reduction surgery?
• What are the benefits of lung volume reduction surgery?
• Who is a candidate for lung volume reduction surgery?
• What are the risks associated with lung volume reduction surgery?
• Is lung volume reduction surgery common? Is it widely available?
• What are the alternative treatments to lung volume reduction surgery?
• How can I find out if I am a candidate for lung volume reduction surgery?

Q. What is lung volume reduction surgery?
A. Lung volume reduction surgery (LVRS) is a procedure where surgeons remove portions of diseased lung tissue damaged by severe emphysema. By removing poorly functioning tissue, remaining lung tissue can work more efficiently. At the University of Chicago, our thoracic surgeons perform LVRS using video assisted thoracoscopic minimally invasive techniques that do not require large incisions.

Q. What conditions can be treated with lung volume reduction surgery?
A. LVRS is an option for some people with severe emphysema, a chronic lung condition in which the alveoli--or air sacs--of the lungs are damaged and trap air. People with emphysema experience breathlessness, coughing, fatigue, and other problems because their lungs do not function properly.

Q. What are the benefits of lung volume reduction surgery?
A. There are many potential benefits of LVRS. Benefits include:

• Greater ability for the lungs to inflate and deflate properly, which improves breathing
• Many patients report a reduced need to rely on portable oxygen tanks
• The diaphragm (the breathing muscle) and the chest wall are abnormally positioned due to severe emphysema. LVRS provides room for the diaphragm and the chest wall to return closer to their normal positions, which also improves breathing ability.

Most patients who have been selected for LVRS report a great improvement in their overall quality of life. Better breathing means less fatigue and more energy to enjoy life.

Q. Who is a candidate for lung volume reduction surgery?
A. Not everyone with severe emphysema is a good candidate for LVRS. Being a good candidate for LVRS is an important factor for surgical success. A large, nationwide study completed in 2005 found that people with severe emphysema in the upper lobes of the lungs with decreased exercise capacity benefit the most from LVRS. The study also showed that patients who do not meet the criteria would receive little or no benefit from LVRS.

The University of Chicago Medicine pulmonary team is highly skilled in determining which patients with severe emphysema are likely to benefit from LVRS. Each patient identified as a possible candidate for LVRS must undergo a thorough evaluation. Candidates must not smoke for several months prior to evaluation and following the procedure. In addition, patients are required to undergo pulmonary rehabilitation before and after surgery.

Q. What are the risks associated with lung volume reduction surgery?
A. LVRS is an elective surgery, and as with any type of surgery, there are risks. The benefits of the surgery are not immediate, and may take time to be fully realized. Complications such as pneumonia, infection, and air leaks within the chest cavity can occur. Ultimately, there is no guarantee that the surgery will work.

Q. Is lung volume reduction surgery common? Is it widely available?
A. LVRS is a rare surgery, and it is only performed at select medical centers. The University of Chicago Medicine is currently the only hospital in Illinois to offer LVRS. LVRS requires a comprehensive team approach that can only be delivered by an experienced team of thoracic surgeons, pulmonologists, anesthesiologists, and nurses who specialize in complex lung disease.

The University of Chicago Medicine is home to one of the most respected thoracic teams in the nation -- a team that includes a surgeon who has vast expertise in LVRS, lung transplantation, and several other types of major lung procedures. Our pulmonologists have earned acclaim for offering innovative diagnostics and treatments. U.S.News & World Report ranks our respiratory program among the best in the nation, and the highest in Illinois.

In the 1990s, LVRS was more common and was performed at many hospitals that did not have the proper framework or expertise to perform the procedure. Over time, it was apparent that some patients who had LVRS were not faring well, so Medicare (the nation's largest health insurance program) stopped paying for the surgery. Medicare initiated a study to determine which people with emphysema are the best candidates for the procedure. The study was completed in 2005 and led to specific guidelines for surgical candidates and reimbursements by Medicare.

Q. What are the alternative treatments to lung volume reduction surgery?
A. Some alternative treatments to LVRS include the following:

• Oral medications
• Antibiotics to treat infections
• Bronchodilators and other inhaled medications
• Exercise, including breathing exercises to strengthen the muscles used in breathing as part of a pulmonary rehabilitation program
• Oxygen supplementation from portable containers
• Endoscopic lung volume reduction (experimental at present)
• Lung transplantation

Patients who currently smoke are strongly encouraged to quit and will not be considered for surgical treatment. Smoking is the leading cause of emphysema.

Q. How can I find out if I am a candidate for lung volume reduction surgery?
A. To find out if you or a loved one may benefit from LVRS, talk with your pulmonologist or contact us at (773) 702-3551, toll-free at 1-888-UCH-0200, or request an appointment online.

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