Role of surgery in lung emphysema

Lung emphysema is associated with high morbidity and morality rates. During the last decades, different surgical procedures have been performed in the management of the bullous (bullectomy) and diffuse emphysema (lung transplantation or lung volume reduction surgery). Bullectomy is applied in those patients affected by large or giants bullae causing functional impairment or secondary pleural or pulmonary pathologies such as empyema, hemoptysis or pulmonary infections. During the '80s lung transplantation became a reality in the treatment of end-stage pulmonary emphysema in selected patients. After lung transplantation, single or bilateral, significant improvement of the functional status and quality of life are referred, even if the residual life is limited by chronic rejection and infections. Lung volume reduction surgery, performed the first time in 1957 by Brantigan and Mueller, has been re-discovered by Cooper et al. in the '90s. The most affected areas of the lung, previously detected by high resolution computed tomography and perfusion scintigraphy, are excised by multiple wedge resections. This procedure allows reduction of the lung volumes, improvements in the thoracic mechanic stich as the pulmonary function and exercise tolerance with significant reduction of dyspnoea and disease-related symptoms. Unfortunately, these results are limited and the progression of the underlying disease restores the preoperative conditions in 12-24 months even in selected patients.