A perspective on the role of surgery in chronic obstructive lung disease.

As can be judged by reading the description of these operations, much has been done throughout the twentieth century to try to improve the quality of life of emphysema patients. At the time of their description, all procedures were based on what appeared to be clear understanding of the pathogenesis of the disease, and all were championed by leading surgeons, mostly in Europe and in the United States. Early results were always encouraging, but the severity of emphysema and the wrong understanding of the problem were the limiting factors for sustained good results. In addition, clinical and functional results of surgery were difficult to assess because all reported series were small and inconsistent, and because no controlled trial was ever done to compare the results of standard medical therapy with that of surgery. It is also clear that the general failures of surgery to predictably improve dyspnea in emphysematous patients relates to the nonavailability of an experimental model in which physiologic parameters of success could be evaluated.