Lung volume reduction surgery (LVRS) has shown an improve for up to several years respiratory function, exercise capacity, and quality of life in selected patients with severe emphysema and low exercise capacity, particularly if upper-lobe predominance of disease is radiologically recognized. However, mortality and morbidity rates of LVRS have been not negligible leading to raising question as to the cost-effectiveness of the procedure and resulting in a progressive decline in its use although a considerable number of patients meet selection criteria and could potentially benefit of this treatment modality. In recent years, an active investigation aimed at developing less invasive strategies that might allow us to achieve long-term results as satisfactory as those of the standard LVRS method but with fewer adverse effects has been undertaken. So far, novel options including nonresectional surgical and endoscopic LVRS methods hold promise but results from large studies with long follow-up are awaited to help define the most effective interventional treatment options for patients with severe emphysema. In this literature review an analysis of the main issues related to LVRS including selection criteria, mechanisms of action, results of currently available surgical and endoscopic methods, and some potential future perspectives is provided. 1. Introduction Emphysema, one of the recognized chronic obstructive pulmonary disease (COPD) phenotypes, is an incurable, highly prevalent, and underdiagnosed condition, which represents the 4th cause of death in adults worldwide [1]. It is defined as an abnormal permanent enlargement of air spaces distal to the terminal bronchiole associated with destruction of their walls [2]. Pathophysiology of emphysema include reduced area for gas exchange and decreased lung elastic recoil with early expiratory airway collapse and increased airflow resistance resulting in lung hyperinflation. This effect is exaggerated during exercise when dynamic hyperinflation further impairs respiratory mechanics, increases work of breathing, and may even hinder cardiac filling, leading to dyspnea and reduced exercise performance. The cascade of detrimental effects of emphysema eventually impairs quality of life and increases mortality [3–6]. In the last 2 decades lung volume reduction surgery (LVRS) has emerged as an effective treatment modality, which can reverse detrimental effects of emphysema for a variable period of time leading to significant and long-lasting improvements in respiratory function, exercise capacity, quality of life, and
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