Berger RL, Decamp MM, Criner GJ et al.
Beth Israel Deaconess Medical Center, Boston, MA, USA.
Editor’s note: The increasing use of lung volume reduction surgery (LVRS) in the absence of adequate proof of its efficacy led to the instigation of NETT (National Emphysema Treatment Trial). NETT showed a survival advantage and an advantage in terms of improvement in exercise tolerance and quality of life with LVRS compared with conventional management in patients with predominantly upper lobe disease and impaired exercise tolerance but who did not have respiratory failure (N Engl J Med 2003;348:2059–73). Despite these positive results, the use of LVRS has been minimal, with very few operations performed per year, even in the US. The authors of this update on LVRS are clearly frustrated by this, although in this Editor’s opinion, the reason seems understandable given that there remains a significant perioperative mortality rate and that properly informed patients do not seem to be willing to undertake this risk.