Bilateral lung volume reduction surgery outperforms the unilateral approach in functional improvement.

Lung volume reduction surgery is an established treatment approach for patients with severe pulmonary emphysema, enhancing lung function and quality of life in selected patients. Functional benefits and outcomes after uni- versus bilateral lung volume reduction remain a topic to debate. A retrospective analysis of patients undergoing lung volume reduction surgery from January 2018 to October 2022 was conducted. After encouraging initial results, the standard unilateral lung volume reduction surgery approach was switched to bilateral. This study aimed to assess the impact on functional outcomes at three and six months post-surgery compared to preoperative levels for the uni- versus bilateral approach. A total of 83 patients were included (43 bilateral, 40 unilateral). Baseline demographic and functional parameters were comparable between groups. The most common complication was prolonged air leak occurring in 19 patients (11 in unilateral group, 8 in bilateral group). Two patients died perioperatively (2.4%). Overall, lung volume reduction surgery improved Forced Expiratory Volume in 1 second by 8.3% after 3 and 12.5% 6 months postoperatively compared to baseline. Bilateral surgery presented significantly superior Forced Expiratory Volume in 1 second improvement than unilateral approach at both 3 (29.2% versus 2.9%; p = 0.0010) and 6 months (21.5% versus 3%; p = 0.0310) postoperatively. Additionally, it reduced hyperinflation (residual volume) by 23.1% after 3 months and 17.5% after 6 months, compared to reductions of 16% and 9.1% in the unilateral group. Bilateral approach resulted in better functional outcomes 3 and 6 months postoperatively compared to unilateral surgery.

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© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.