34. COMPARISON OF CLINICAL RESULTS FOR UNILATERAL AND BILATERAL THORACOSCOPIC LUNG VOLUME REDUCTION
Greg A. Lowdermilk, Robert J. Keenan, Rodney J. Landreneau, Stephen R. Hazelrigg, Joseph E. Bavaria, Larry R. Kaiser, Keith S. Naunheim*
St. Louis University School of Medicine
St. Louis, Missouri, USA
BACKGROUND
It is widely held that bilateral thoracoscopic lung volume reduction (BTLVR) yields superior results when compared to unilateral thoracoscopic lung volume reduction (UTLVR). However, these beliefs are based on comparisons of small series of patients (pts). In order to address these issues we compared the results of UTLVR (n=338 pts) and BTLVR (n=344 pts) who were operated on between 1993 and 1999 at five institutions. Follow-up was obtained between six and twelve months following surgery.
RESULTS
|
|
UTLVR |
BTLVR |
P -value |
|
Operative mortality |
5% |
7% |
NS |
|
D FEV |
+23% |
+33% |
0.037 |
|
D RV |
-15% |
-21% |
0.015 |
|
D PO2 (mm Hg) |
+4.5 |
+4.3 |
NS |
|
Decreased 02 utilization |
78% |
74% |
NS |
|
D 6 minute walk |
+26% |
+31% |
NS |
|
Improved QOL |
79% |
88% |
0.02 |
These data suggest that both UTLVR and BTLVR yield improvement. BTLVR provides superior improvements in spirometry and quality of life. Quantification of oxygenation, oxygen use, and functional capacity failed to show an advantage for either approach.
CONCLUSION
These data suggest that BTLVR may provide greater relief of dyspnea symptoms but that UTLVR is equally effective in improving oxygenation and functional status.
