Surgical and Bronchoscopic Lung Volume Reduction for Severe Emphysema: A Systematic Review and Network Meta-analysis.

Summary

Across 25 RCTs (4,283 patients), LVRS achieved the largest functional gains (FEV1, 6MWD, dyspnea) but increased mid-term mortality (RR 3.26). EBV and endobronchial coils improved outcomes but raised pneumothorax risk, with EBV slightly increasing mortality (RR 2.06). Results support individualized selection balancing efficacy and risk.

Key Findings

• Included 25 RCTs (n=4,283) comparing seven LVR modalities versus standard care.
• LVRS provided the largest improvements in FEV1, 6MWD, and symptoms but increased mid-term mortality (RR 3.26; 95% CrI 1.98–6.21).
• EBV improved function but increased pneumothorax and slightly increased mid-term mortality (RR 2.06; 95% CrI 1.07–4.36).
• Endobronchial coils (EBC) showed efficacy but with pneumothorax risk; long-term survival data for BLVR remain limited.

Clinical Implications

LVRS should be reserved for carefully selected patients who can tolerate higher early mortality risk in exchange for maximal functional gains; EBV/EBC are alternatives where fissure anatomy and collateral ventilation permit, with vigilant pneumothorax monitoring and shared decision-making.

Limitations

• Mid-term (≤6 months) mortality focus limits inference on long-term survival.
• Heterogeneity in patient selection, fissure completeness, and procedural expertise.

Future Directions

Head-to-head trials and patient-level network meta-analyses with standardized pneumothorax management and long-term survival endpoints to refine modality selection.