HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Eugenio Pompeo Tommaso Claudio Mineo Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pompeo, E. Articles by Mineo, T. C. Search for Related Content PubMed PubMed Citation Articles by Pompeo, E. Articles by Mineo, T. C. Related Collections Lung - other

Eur J Cardiothorac Surg 2002;21:627-633
© 2002 Elsevier Science NL

Long-term outcome of staged versus one-stage bilateral thoracoscopic reduction pneumoplasty

Department of Thoracic Surgery, Tor Vergata University, Policlinico Tor Vergata, Via Oxford 81, 00133 Rome, Italy

Received 15 September 2001; received in revised form 21 December 2001; accepted 8 January 2002.

* Corresponding author. Tel.: +39-6-5100-2594; fax: +39-6-592-2681
e-mail: pompeo{at}med.uniroma2.it

Objective: In a prospective non-randomized study, we tested the hypothesis that unilateral reduction pneumoplasty followed by completion of bilateral treatment at the reappearance of symptoms might result in more sustained improvements and better survival than one-stage bilateral treatment. Method: Fifty-nine patients undergoing bilateral thoracoscopic reduction pneumoplasty as a one-stage (n=33) or staged (n=26) procedure were evaluated on. The main indication for staged reduction pneumoplasty was symptom deterioration after unilateral treatment for asymmetric emphysema. Complete clinical assessment was carried out preoperatively and every 6 months postoperatively. Results: The mean length of follow-up was 34±15 months. Interval time between operations in the staged group averaged 15.2 months. There was no inter-group difference in baseline data. Peak improvements in forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC) and residual volume (RV) was significantly greater following one-stage bilateral reduction pneumoplasty. In particular, FEV₁ was 0.33±0.2 l in the staged group and 0.43±0.2 l in the one-stage group (P=0.007). At 48 months, FEV₁, RV and 6-min-walking-test (6MWT) were still significantly improved only in the staged group. Four-year survival was 70% in the staged group and 81% in the one-stage group (Cox–Mantel test, P=not significant). Conclusion: Durable physiological improvements and satisfactory survival were achieved in this study for up to 4 years following either staged or one-stage bilateral reduction pneumoplasty using thoracoscopic technique. However, while peak improvements in FEV₁, FVC and RV were significantly greater following one-stage bilateral reduction, long-term improvements in FVC and 6MWT were more stable following a staged procedure. We speculate that sequential unilateral reduction pneumoplasty may reduce the mechanical stress in the lung leading to less steep postoperative deterioration of respiratory function.

Key Words: Reduction pneumoplasty • Lung volume reduction surgery • Pulmonary emphysema • Thoracoscopy

This article has been cited by other articles:

				A. E Martin-Ucar, K. R Fareed, A. Nakas, P. Vaughan, J. G Edwards, and D. A Waller Is the initial feasibility of lobectomy for stage I non-small cell lung cancer in severe heterogeneous emphysema justified by long-term survival? Thorax, July 1, 2007; 62(7): 577 - 580. [Abstract] [Full Text] [PDF]

				E. Pompeo, E. De Dominicis, V. Ambrogi, D. Mineo, S. Elia, and T. C. Mineo Quality of life after tailored combined surgery for stage I non-small-cell lung cancer and severe emphysema Ann. Thorac. Surg., December 1, 2003; 76(6): 1821 - 1827. [Abstract] [Full Text] [PDF]