043 * the Predictive Role of "physiological" Heterogeneity in the Outcome of Lung Volume Reduction Surgery
Year: 2014
Type: article
Abstract: Objectives: The best outcomes from lung volume reduction surgery (LVRS) are obtained in patients with heterogeneous, upper-lobe predominant emphysema. An anatomical assessment of heterogeneity is made by computed tomography in most centres. We have preferred an assessment of “physiological” heterogeneity using radionuclide scintigraphy, calculating the percentage of total lung perfusion in the apical one-third of the operated lung: the Q score. We have analysed the predictive value of this method. Methods: We have performed LVRS in 254 patients since 1997 and have prospectively collected outcome data on physiological, nutritional and health status parameters. All patients have been selected on the basis of the Q score. We have correlated the preoperative Q score with postoperative changes in FEV1, RV/TLC, body mass index (BMI) and the EuroQol EQ-5D in 198 patients with complete follow-up at 3, 6 and 12 months after unilateral video-assisted thoracoscopic surgery (VATS) LVRS. Results: There were significant improvements in FEV1 (27.4 ± 25.7%) and RV/TLC (14.6 ± 29.5%) at 3 months and BMI (4.6 ± 7.6%) and the best EQ-5D (8.9 ± 35.9) during the 12 months post LVRS (P < 0.05). The preoperative Q score was significantly associated with FEV1 improvement at 3 months with an inverse correlation (P < 0.05, r = –0.237), as shown in Fig. 1. An inverse but not significant correlation is also demonstrated with BMI improvement (P = 0.136). Conclusion: Patient selection for VATS upper lobe LVRS based on “physiological” rather than “anatomical” heterogeneity is justified. This measure allows prediction of improvement in airways obstruction.
Institutions: Glenfield Hospital, Agostino Gemelli University Polyclinic
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2047287442