Abstract
Lung volume reduction surgery is an old operation that was recently revived as a surgical treatment for patients with severe emphysema, a disease for which there are few other therapeutic options. It appears that, by removing some portion of the diseased lung tissue, the elastic recoil of the remaining tissue is improved, resulting in increased expiratory airflow, and the respiratory muscles are allowed to operate at closer to their optimal force-generating length, resulting in increased inspiratory force. Although a significant amount of experience has been gained with the procedure, and there is now little doubt that a subgroup of patients benefit from the operation when performed in centers equipped to care for this challenging patient cohort, a wide variety of questions remain to be answered. These areas of controversy include issues as far ranging as patient selection, surgical technique, durability and extent of benefit, and remaining basic issues surrounding the physiological mechanism of effect. The National Emphysema Treatment Trial has been organized to address many of these outstanding questions. It is hoped that this trial will confirm early reports documenting the benefits to be gained from the procedure and help guide application of the operation in the future.
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