The safety and efficacy of lung volume reduction surgery: A 25-year single institution experience.

OBJECTIVE: Lung volume reduction surgery (LVRS) in well-selected patients significantly improves lung function. Regardless of its proven effects, LVRS is still widely underused worldwide. In this overview, we demonstrate our 25 years of experience in the largest single-center cohort. METHODS: Retrospective analysis of prospectively collected data on patients undergoing LVRS at the Department of Thoracic Surgery, University Hospital Zurich between November 2000 and February 2025 is presented, including functional outcomes. RESULTS: Seven hundred thirteen patients (323 women [45.3%]) with a median age of 65 years (range, 59-71 years) and predominantly heterogeneous morphology (70.3%) needing in 38.9% permanent oxygen supply underwent LVRS (93.7% minimally invasive approach, 43.1% bilateral). All relevant lung function parameters had improved significantly at the 6-month follow-up (change [Δ] forced expiratory volume in 1 second: +22.0% predicted, Δ residual volume: -762.2 mL, Δ total lung capacity: -418.1 mL, Δ residual volume to total lung capacity ratio: -10.3%, Δ diffusing capacity of the lungs for carbon monoxide: +3.2, and Δ 6-minute walk distance: +32 m; all P values < .001). The most common postoperative complication was prolonged air leak (27.2%), necessitating redo surgery in 78 (10.9%) patients. In-hospital mortality was 0.7%, and 90-day mortality was 2.1%. The 1- and 5-year survival rates were 93.4% and 52.1%, respectively. Body mass index below 18.5 and higher intraoperative Paco2 were associated with poorer survival. CONCLUSIONS: LVRS leads to a significant improvement of all key lung function parameters, with low in-hospital mortality in this very fragile patient cohort.