ABSTRACT
Most pulmonologists, internists, and thoracic surgeons have shared the challenges of caring for patients with advanced emphysema. Although oxygen therapy has had a substantial impact on the natural history of the disease (reviewed in Chap. 5), the clinician caring for patients with emphysema often feels that they are bailing a continuously leaking boat, just hoping to stem the tide of disease progression. The reintroduction of lung volume reduction surgery (LVRS), therefore, changes the perspectives of both physician and patient by introducing the hope of a substantial improvement beyond that expected from medical therapy. It also puts the patient and physician in the seemingly paradoxical position of contemplating elective major chest surgery in a patient whose lung disease is conventionally felt to be a contraindication to major surgical procedures of all types.
