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Patient selection for lung volume reduction surgery: is outcome predictable?

Patient selection for lung volume reduction surgery (LVRS) relies on sound physiologic concepts and experience from large case series. LVRS should be considered in severely symptomatic emphysema with marked airflow obstruction and hyperinflation despite optimal medical management, and in the absence of major comorbidities associated with excessive perioperative risks. Qualitative estimation of functional benefit from LVRS in suitable candidates has been based on functional criteria (e.g., high inspiratory conductance, high residual volume/total lung capacity ratio), on heterogeneity of emphysema assessed by computed tomography (CT) or perfusion scans, and on severity of emphysema assessed by CT or impaired diffusing capacity. Selection strategies relying on such criteria have provided favorable functional results at a low mortality, but further validation of potential outcome predictors in prospective trials is needed.