Reduction of low attenuation areas of emphysema after lung volume reduction surgery compared to bronchoscopic lung volume reduction with valves

Background: Lung volume reduction surgery (LVRS) enables a tailored resection of emphysematous lung areas, whereas bronchoscopic lung volume reduction (BLVR) with valves excludes a whole lobe. We hypothesize greater reduction of areas with low attenuation on computed tomography (CT) scans by LVRS, assuming to spare still functioning tissue, compared with BLVR. Methods: LVRS patients were prospectively collected and a post-hoc analysis was performed to compare patients after BLVR with valves. Pre- and postoperative (3 months after LVRS, 1 months after BLVR) lung function, 6-minute walking distance (6-MWD) and changes in low attenuation areas (LAA, ≤- 950 hounsfield units) in CT was measured. The BLVR group needed proven target lobe atelectasis to be included. Primary endpoint was the radiologically measured LAA reduction. Conclusion: Neither LVRS nor BLVR seem to be superior in sparing or eliminating still functional tissue, as both methods showed no differences in reduction of LAA. This information might contribute to the decision at an interdisciplinary emphysema board, where all cases are preferably discussed.