The Reporter: Feb 1995, Vol.6, No.1
Lung Surgery for Advanced Emphysema Patients

Columbia has joined a handful of medical centers in the country to offer a procedure aimed at prolonging life for advanced-stage emphysema patients with hyperinflated lungs. The procedure, called lung reduction surgery, involves removing portions of dise ased lungs to improve breathing capacity.

"What the procedure does is reduce the lungs to a more normal size," says Dr. Mark Ginsburg, P&S assistant clinical professor of surgery and associate director of general thoracic surgery. "Emphysema is often a patchy disease. There are areas of good lung and bad lung, and we remove as much of the emphysematous lung as we can. We remove between 20 and 40 percent of the lung volume so the lung size is brought down to normal."

First practiced in the 1950s, this lung procedure was resurrected a year ago by Dr. Joel Cooper at Washington University in St. Louis. It typically involves a sternotomy but in some cases requires a bilateral thoracotomy.

Dr. Ginsburg began using the two-hour procedure at Columbia in September 1994. Though he reports positive results so far, he takes a conservative approach on recommending the surgery for all patients with advanced emphysema. "It is hoped that the res ults will be long-lasting, although only time will tell. The long-term results are not in yet. The continued improvement that seems to occur in patients over a year out appears to be from reconditioning of the chest wall muscles."

Advanced emphysema patients who haven't become totally disabled or totally crippled by high-dose steroids tend to benefit most from the surgery, says Dr. Ginsburg. "What we don't know is whether those patients with advanced disease can go through the surgery consistently. We don't know what their long-term outcome will be. We're just starting to learn who to apply it to."