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PubMed | University Hospital Gasthuisberg 49
Type: Journal Article | Journal: Acta clinica Belgica | Year: 2016

Emphysema is a disabling disease, for which there is no curative therapy available today. Lung transplantation offers a valuable option for a very selected number of patients, however, due to the enormous organ shortage, only few patients can be offered such a therapy. Recently there has been important resurgence of interest in lung volume reduction surgery and as a consequence, we have embarked in such a program since may 1997. We have now performed unilateral lung volume reduction surgery in 29 emphysema patients (25 on the right and 4 on the left side). Twenty-four patients were already discharged home. There has been no perioperative mortality. The mean hospital stay was 19.8 11.4 days (range, 8-47 d). Twenty patients of whom we already have follow-up data during 6 months (m) form the further basis of this report. Six weeks after the procedure the FEV1 increased from 0.82 0.28 L (28 8%) to 1.05 0.39 L, a mean increase of 28%. There was a further increase of the FEV1 to a maximum of 1.06 0.42 L at 6 m, a mean maximum increase of 29% (p=0.0046, ANOVA). Sim-ilarly, the FVC increased from 2.801.10Lto3.15 1.00 L, a mean increase of 12.5%. A further increase was also obtained at 6 m and was 19.6% (3.35 1.05 L, p=0.014, ANOVA). The maximum decrease in RV was obtained at 3 m (from 5.91 1.37 L to 4.37 0.85 L (p=0.0001, ANOVA), a mean decrease of 26%. The maximum TLC decrease was demonstrated at 3 m (from 8.71 1.71 L to 7.60 1.56 L (p=0.002, ANOVA), a mean decrease of 12.8%. Afterwards there was again a gradual raise of the TLC. The six minute walking distance increased from 231 31 m to 272 34 m (p=NS) after pulmonary rehabilitation and to 416 i 77 in at 3 m and 415 18 m at 6 m (p=0.0002, ANOVA) after the operation. The quality of life (measured with a standardized questionnaire, the Nottingham Health Profile ) improved significantly in several domains (e.g. mobility, pain, energy, emotions and social) at 3 m postoperatively. There was one late death (at 6 m) due to an unknown cause. The actuarial survival rate was therefore 100% at 3 m and 95% at 12 m. In conclusion, unilateral thoracoscopic lung volume reduction surgery is a new and safe treatment modality for patients suffering from severe end-stage emphysema. The objective and subjective improvement is marked and the mortality is very low. Rigid selection criteria are, however, necessary to be able to guarantee an optimal result.

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