Emphysema is a progressive disease that in some cases will significantly compromise the quality of life for people with severe emphysema. Inhalers may help only about 10% of people with severe emphysema. Because medical management has provided only minimal impact on the disease, a variety of surgical procedures have been tried. Our surgeons helped to develop surgical treatments for emphysema and have written over 100 journal articles about that topic. The most effective operation has been lung volume reduction surgery (LVRS).
- Symptoms: Patients who are symptomatic despite maximal medical management for severe emphysema. They usually complain of shortness of breath with activities of daily living, such as showering, carrying, walking short distances, and bending.
- Pulmonary Function Test: Severe obstructive lung disease, with typically the following PFTs: FEV1 20-40% predicted, TLC > 120% predicted, RV > 200% predicted.
- Imaging: CXR shows hyperinflated lungs with a depressed diaphragm. CT scan shows heterogeneous pattern of emphysema in the lungs (generally much worse in upper lobes, than in the lower lobes). This is usually confirmed with a lung perfusion scan.
- LVRS: Our surgeons have published 100 journal articles about how the operation works, patient selection and results. About 50-75% of both the right and left upper lobes are resected. This can be performed with VATS or a median sternotomy. Average length of stay is 7 days. Mortality rate is about 2%. 80% of patients develop air leak from the lung so their chest tubes may remain > 1 week after the procedure. About 75% of people on oxygen before the operation will no longer need the operation after they recover from the operation.
- National Emphysema Treatment Trial (NETT): a study supported by the NIH and Medicare to compare surgery and medical treatment for severe emphysema. Dr McKenna was one of the principal investigators for the study.