Lung Volume Reduction in Patients with Severe Emphysema: Bronchoscopic Lobar versus Surgical Tailored Treatment

Abstract Background Bronchoscopic lung volume reduction (BLVR) with valves excludes one whole lobe while surgery (LVRS) allows tailored treatment by resection of only heterogeneous, hardly perfused target areas. Aims We hypothesize that (bilateral) LVRS, more areas low attenuation (LAA, ≤ - 950 houndsfield units) can be resected precisely, thus generating functional improvement than BLVR. Methods Empysema patients treated BLVR and LVRS at our institution between August 2019 October 2020 were collected prospectively analyzed retrospectively. responders defined as a postoperative least 10% in FEV1 combination delta 6-minute-walking-distance (6MWD) or residual (RV) diffusion capacity (DLCO), within the group additionally chest CT scan proven atelectasis. performed LAA measurement preoperative 3 months 1 month postoperatively. Functional well was measured each groups compared other. Results 29 underwent 19 (5 bilateral 14 unilateral), lost for follow up. Within (n=29), 18 responders. In 6MWD significantly higher BLVR, accompanied LAA-reduction (22.18 vs 9.54, p=0.009). unilateral not (12.06 p=0.267), still showed improvement. RV DLCO did differ groups. Conclusions might lead to valves, maybe due LAA, especially surgery. This concept may justify favoring primary over heterogeneous emphysema.