Surgical Outcome of Giant Emphysematous Bullae Based on Long-Term Follow-up Changes in Respiratory Function

Abstract

Objective : The purpose of this study was to evaluate the long term outcome of surgery and operative indication for giant emphysematous bullae based on early and long term changes in respiratory function after surgical treatment. Materials : Forty-one patients (42 interventions) with resection of giant emphysematous bullae occupying 50 % or more of hemithorax were included in this study. Thirty-nine patients were males and 2 females. Age at the time of operation ranged from 25 to 75 years, with a Meanage of 48.2 ± 10.3 years. Methods : Surgical approaches were median sternotomy in 26 patients, posterolateral thoracotomy in 14, axillay thoracotomy in 1 and thoracoscopy in 1. Procedures were bullectomy or plication of bullae and there was no lobectomy. Check indices of respiratory function at pre and postoperative were vital capacity (VC), %VC, forced expiratory volume in 1 second (FEV₁), FEV₁ %, % FEV₁, peak expiratory flow rate (PEFR), V₅₀, V₂₅, residual volume (RV), residual volume rate (residual volume/total lung capacity : RV/TLC), PaO₂ and PaCO₂, and the ratios of postoperative value to pre operative value were calculated. Respiratory function was investigated before and 1st month, 3rd month, 6th month, 1st year to 5th year postoperatively. Measurement and Results : Patients were divided into four groups according to their preoperative FEV₁ values. Group 1 (FEV₁≤1000ml) consisted of 7 cases. Group 2 (1000ml<FEV₁≤2000ml) consisted of 11 cases, Group3 (2000ml<FEV₁≤3000ml) consisted of 15 cases and Group 4 (3000ml<FEV₁) consisted of 9 cases. Postoperative FEV₁ was significantly increased (0.70±0.201→1.21±0.31 : P<0.001) immediately after operation in Groups I and II (1.72±0.31→2.07±0.41 : P<0.05). There was no significant change of FEV₁ in Group III and IV. Significant improvements of FEV₁ %, V₅₀ and V₂₅ as indices for obstructive ventilatory impairment were observed in all 4 groups. Respiratory functional improvements were maintained for 5 years after operation, whereas FEV₁, FEV₁ %, V₅₀ and V₂₅ of Group I gradually decreased during the long term follow up after operation. VC of Group III and IV decreased in the early postoperative period and returned to preoperative values in 6 months to 1 year. Two patients out of seven patients in Group I died of chronic respiratory distress at 70 and 118 months after operation. Conclusions : Respiratory functional improvements after surgical treatment for giant emphysematous bullae were significaut in the patients with FEV₁ under 2000ml, and they maintained clinical and physiologic improvements for 5 years after surgery. However, there was no significant improvement in the patients with FEV₁ over 2000m1 without complications, which suggests that surgery should not be indicated for such patieuts.