Subjective symptoms and prognosis after lung volume reduction surgery in patients with severe pulmonary emphysema.

Lung volume reduction surgery improves symptoms in patients with severe pulmonary emphysema, but patients are not always satisfied surgical results. Our purpose was to determine the profiles and prognosis of unsatisfactory cases of lung volume reduction surgery. A total of 58 patients with advanced symptomatic emphysema underwent thoracoscopic volume reduction of emphysematous lung tissue. Patients subjectively evaluated their condition 3 months after surgery as "better," "same," or "worse" than before surgery. Of these, 30 evaluated themselves as "better" (58%), 17 as the "same" (33%), and 4 (8%) as "Worse." Most patients with vital capacity (VC) exceeding 2,000 mL (percentage of vital capacity for the predicted value (%VC) of > 60%) with upper-lobe-predominant and centrilobular emphysema were satisfied with surgical results. All patients with lower-lobe-predominant or whole-lung panacinar emphysema evaluated their results as "worse." Six late deaths occurred due to pulmonary infection (3), respiratory failure (2), and an unknown sudden cause (1), with most of these patients having preoperative low VC and high postoperative partial carbon dioxide pressure in the arterial blood (PaCO2).