Lung Volume Reduction Surgery for Cannabis-Associated Emphysema: Expanding Indication With Functional and Quality of Life Improvements

OBJECTIVES: Cannabis-associated emphysema (CAE) involves bullous parenchymal destruction, often not considered for surgery due to the severe destruction and fragile tissue. It is affecting younger patients with limited smoking history, compared to typical emphysema. Given the heterogeneous pattern, lung volume reduction surgery (LVRS) may offer therapeutic benefit. This study explores the role of LVRS in patients with CAE. METHODS: CAE patients were analyzed from a prospective collected database from August 2019 until December 2024. Chest computed tomography scan, lung function (forced expiratory volume in 1 second FEV1, residual volume RV, quality of life COPD Assessment Test, CAT) and operative outcomes were measured up to one-year postintervention. RESULTS: Seven patients (median 53 years (range, 40-70), all male) with 14 joint-years (3-168) underwent 11 LVRS procedures. Four patients experienced a previous pneumothorax. The median length of stay was 6.5 days (3-14), with a chest tube duration of 5.5 days (2-14). Air leaks occurred in 7 procedures (58%) for a median of 7 days (1-10), with prolonged air leak in 3 cases (27%). There was no mortality or readmission. Relative improvement at 6 to 12 months regarding FEV1 was +44% (36-108) and RV -43% (11-62). Six-minute walking distance and CAT improved with +72 m (-28 to 152) and 11 (0-17) points, respectively. CONCLUSIONS: This preliminary single-center case series suggests that CAE may represent a suitable indication for properly performed LVRS, with favorable results attributable to its heterogeneous morphology.