Lung Volume Reduction Surgery for Emphysema Treatment: State-of-the-Art and Perspectives

Table 1

Suggested main selection criteria for LVRS.

Inclusion criteria	Exclusion criteria
Age ≤ 80 years	BMI < 18 > 29
Severe, heterogeneous emphysema, preferably predominant in the upper lobes at the HRCT.	Severe, homogeneous emphysema with no target areas for LVRS at the HRCT.
Dyspnea at rest or with minimal physical activity; (MMRC score ≥ 3).	Need of ventilatory assistance.
Moderate to severe obstructive defect with FEV1 ≤ 45% but > 20% predicted.	DLCO < 20% predicted by the single breath technique.
Functional aspects of hyperinflation with residual volume >180% predicted and total lung capacity >120% predicted on body plethysmography.	Significant bronchitis with increased inspiratory airway resistance and/or abundant daily sputum production.
Resting room; PaO2 > 45 mmHg	Resting PaCO2 > 55 mmHg
Impaired exercise capacity but 6MWT distance > 140 m.	Pulmonary hypertension with mean PA pressure >35 mmHg or peak systolic PA pressure >50 mmHg on Doppler echocardiography.
ASA score ≤ 3.	Any comorbid condition that would significantly increase operative risk.
Quit smoking for at least 4 months.	Neoplastic disease with life expectancy < 12 months.

HRCT: high-resolution computed tomography; LVRS: lung volume reduction surgery; MMRC: modified Medical Research Council dyspnea score; FEV₁: forced expiratory volume in one second; DLCO: diffusion capacity for carbon monoxide; PaO₂: arterial oxygen pressure; PaCO₂: arterial carbon dioxide pressure; 6MWT: 6-minute walking test; PA: pulmonary artery; ASA: American Society of Anesthesiology score.