Key Points

• Lung volume reduction surgery is a viable option for a select group of patients with emphysema.
• Preoperative pulmonary rehabilitation and meticulous patient selection are essential ingredients for favorable outcomes.
• In appropriately selected patients, LVRS can improve dyspnea, improve exercise tolerance, and may improve survival. Individuals with predominantly upper-lobe emphysema and low baseline exercise capacity represent a subgroup of patients who seem most likely to experience a survival benefit from LVRS.

Over 12 million Americans have chronic obstructive pulmonary disease (COPD). As many as 2 million of these patients have the specific diagnosis of emphysema.[1] Emphysema is a progressive disease that results in a continued decline in pulmonary function. When pulmonary function tests document a forced expiratory volume in 1 second (FEV₁) of less than 30% of the value predicted by nomograms, the 3-year mortality risk has been estimated at 40% to 50%. Medical therapy is the mainstay of treatment for most patients.[2] Although lung transplantation is a viable option, the scarcity of available donors and the presence of associated comorbidities in patients with advanced emphysema limit the transplant option to a select few. An additional surgical therapy—lung volume reduction surgery (LVRS)—has been a viable treatment modality more than 2 decades. In this chapter, we review the physiologic basis of LVRS, the proper selection of patients, and the best data on long term outcomes for the procedure.