SATS 2009 Final Program - Scandinavian Association for Thoracic ...

P01:14
BILATERAL LUNG VOLUME REDUCTION SURGERY FOR SEVERE EMPHYSEMA
Gunnarsson Sverrir I. 1 , Johannsson Kristinn B. 1 , Gudjonsdottir Marta 2 , Magnusson Björn 3 ,
Beck Hans J. 2 , Gudbjartsson Tomas 1
1) Landspitali University Hospital, 2) Reykjalundur Rehabilitation Center, 3) Neskaupstadur Hospital, Iceland
Introduction
Lung volume reduction surgery (LVRS) can be used as a palliative treatment for severe emphysema in appropriately
selected patients. The aim of this study was to evaluate the results of LVRS in Iceland.
Materials and methods
A prospective study of 16 consecutive LVRS patients (age 59 yrs, 10 males) with severe emphysema operated
between 1986 and 2008. Approximately 20% of each lung was excised through a sternotomy, using a linear
stapler. All patients were extubated at the end of the procedure. Function tests were done pre- and 2-4 months
postoperatively.
Results
Average operation time was 86 min. (range 55-135) and hospital stay 26 days (range 9-85). There were no
postoperative deaths and prolonged airleak was the most common complication (n=7). Four patients needed
reoperation; including 3 with sternal dehiscence and one with sternal wound infection. Preoperatively, FEV1 was 0.97
L (33% of predicted) and TLC 7,8 L (132% of predicted), RV 4.5 L (205% of predicted) and exercise capacity 69 W.
Postoperatively FEV1 had increased significantly by 34% to 1,3 L (p=0.004), but other changes were not significant.
Today (April 2009), 10 out of 16 patients are alive, with median crude survival of 96 months (range 9-151).
Conclusion
In this small series, FEV1 significantly improved after LVRS. All the patients survived surgery, however, complications
were common and hospital stay extended. LVRS appears to benefit some patients with severe emphysema. However,
due to small patient numbers our results have to be interpreted cautiously.
P01:15
SURGICAL RESECTIONS FOR GIANT PULMONARY BULLAE
Gunnarsson Sverrir I. 1 , Johannsson Kristinn B. 1 , Asgeirsson Hilmir 1 , Gudjonsdottir Marta 2 ,
Magnusson Bjorn 2 , Gudbjartsson Tomas 1
1) Landspitali University Hospital, 2) Reykjalundur Rehabilitation Center, Iceland
Background
Giant bullae are large dilated air spaces, often occupying more than 1/3 of the hemithorax in patients with emphysema.
The aim of this study was to evaluate the surgical outcome of resections for giant bullae in Iceland.
Materials and methods
A retrospective review of 12 consecutive patients (age 58 yrs, 11 males) with severe emphysema who underwent
bullectomy (8 bilateral and 4 unilateral) in Iceland during 1992-2008. Except for one lobectomy performed through a
thoracotomy all patients were operated with wedge resection through sternotomy. In all cases pre- an postoperative
lung function studies were performed.
Results
Average operation time was 91 min (range 75-150). Preoperatively FEV1 was 1.0 L (33% of predicted) and FVC 2.9
L (68% of predicted). Two months postop an 80% increase in FEV1 was noted (1.8 L, 58% of predicted, p=0.015)
but only 7% increase in FVC (2.9 L, 68% of predicted, p=0.6). All patient survived surgery and the most common
complications were prolonged air leak (>7 days) (n=9) and pneumonia (n=2). One patient was reoperated on for
sternal dehiscience. Median hospital stay was 36 days (range 10-74). Today (May 2009) 7 patients are alive, but the
other 5 patients died 9 yrs median after the operation (100% 5-year survival).
Conclusion
Results of bullectomy in this small series is good. There was a significant increase in FEV1, major complications were
rare and long-term survival acceptable. Prolonged air leak is a common postoperative complication that prolongs
hospital stay of these patients.
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