Low mortality and favourable outcome in lung volume reduction surgery for different emphysema morphologies

Objective A quarter of a century after NETT, lung volume reduction surgery (LVRS) remains an underused procedure with the notion of high mortality and morbidity, mainly recommended for upper lobe predominant heterogeneous emphysema. With advances in patient selection, minimally invasive surgery and improved recovery, this perception may be outdated. This study evaluates five-year single-centre outcome, including patients beyond traditional NETT criteria (non-upper lobe and non-heterogeneous morphology). Methods This prospective study included all consecutive LVRS procedures (08/2019–07/2024). Surgical, functional and quality of life outcomes (COPD assessment test (CAT) and St. Georgés Respiratory Questionnaire (SGRQ)) were analysed at 3 and 6 months, and then annually up to 3 years. Subanalysis compared markedly versus non-markedly heterogeneous morphology, and isolated versus non-isolated upper lobe disease. Results A total of 223 procedures were performed in 191 patients with baseline median FEV 1 : 31%pred (IQR 27–37), RV 219%pred (203–250), 6MWD 358 m (291–439), CAT 22 (18–25) and SGRQ 62 (48–71). Thirty-day mortality was 0.5% (n=1). Hospital stay was 7 days (4–10); prolonged air leak occurred in 17.9%, infection in 2.2%. At 3 years (n=42/191), FEV 1 improved to 38%pred (29–48), RV to 173%pred (148–199), CAT to 20 (17–24), and SGRQ to 55 (39–68), all statistically significant. Morphology was non-markedly heterogeneous in 57.6% and non-isolated upper lobe in 56%, with no significant difference in morbidity. Conclusions This study demonstrates that LVRS performed in a specialised centre results in exceptionally low mortality, morbidity and meaningful clinical and functional improvement, supporting broader indications beyond classical NETT criteria.