Long term results in the surgical treatment of emphysema will ultimately determine the usefulness of the procedures utilized. We studied the results at two years (morbidity, mortality, FEV1 and change in dyspnea scale of a prospectively randomized cohort of emphysema patients.

From June, 1994 to November, 1994, 72 patients with severe bullous emphysema, age 67±7 years were randomized to surgical treatment groups utilizing either laser bullectomy (n=33) or stapled lung volume reduction surgery (n=39). All procedures were performed unilaterally using video-assisted thoracic surgery (VATS). Patients were followed with serial pulmonary function tests and quality of life questionnaires.

Results: At six months (in 62 evaluable of 68 surviving patients), stapled patients experienced a greater improvement in FEV1 (32.9% vs 13.4%, p=0.01), quality of life (the dyspnea scale improved 66% vs 24%, p±0.003) and oxygen independence (87.5% vs 52%, p=0.02). Laser patients experienced a greater risk of delayed pneumothorax (18% vs 0 p = 0.005).

Complete follow-up is now available at two years in 44 of 59 surviving patients. There were 13 deaths (4 early, 9 late) with 8 in the laser group and 5 in the staple group. Eleven patients (5 laser and 6 staple) underwent a second operation (4 bilateral and seven unilateral). Fourteen refused pulmonary function tests.

Of 11 laser patients who experienced >20% improvement in FEV1, three maintained this improvement (2 required a second operation) and 8 returned to baseline. Dyspnea scale (4 representing severe disability and 0 representing no disability) was 2.9 preoperatively and 2.3 at 2 years in laser patients. In staple patients a preoperative mean of 2.8 improved to 1.9 at two years.

Summary: When initially studied, the resectional stapled approach to lung volume reduction surgery appeared superior to laser therapy. At two years this continues to be the case in all categories evaluated although deterioration from the level of function at 6 months postoperatively occurred in both groups.