Quelle place pour la réduction de volume pulmonaire chirurgicale dans l'emphysème ?

Lung volume reduction surgery (LVRS) has been part of the management for the treatment of selected emphysematous patients for two decades. In a large randomized American trial (NETT), lung volume reduction surgery was shown to improve overall survival at 5 years as well as exercise capacity and health-related quality of life, especially in cases of upper-lobe-predominant emphysema and low exercise capacity. Inclusion criteria were pretreatment FEV1 ≤ 45 %, TLC ≥ 100 %, RV ≥ 150 %, room air resting PaCO2 ≤ 60 mmHg and PaO2 ≥ 45 mmHg. Patients with FEV1 ≤ 20 % and either a DLCO < 20 % or homogeneous emphysema were at increased risk of mortality following LVRS and should not be considered for this procedure. Despite this evidence base, lung volume reduction surgery is performed infrequently, competing with lung transplantation and new endoscopic volume reduction techniques.