Lung Volume Reduction Surgery for Emphysema (LVRS)

Current medical treatments of emphysema provide a modest degree of palliation, but there is no medical therapy that dramatically improves emphysema patients' shortness of breath or improves their survival. However, lung volume reduction surgery (LVRS) may be a viable solution for qualifying patients. LVRS is a surgical treatment for emphysema that could dramatically improve symptoms and, in many cases, increase longevity. This link connects to more information about emphysema and LVRS, and here's a video in which Dr. Joseph B. Shrager speaks about emphysema and LVRS in detail. This newer surgical treatment that Dr. Shrager shares has substantially changed the way emphysema is in many cases treated.

Why Choose Stanford?

Dr. Joseph B. Shrager has performed over 100 lung volume reduction surgeries (LVRS) with substantial improvement in shortness of breath and quality of life in nearly all patients and with a mortality rate of 1% (one-fifth of the mortality rate identified in the major published series of LVRS in appropriately selected patients).

Read the publication describing Dr. Shrager’s first 50 bilateral LVRS operations

Dr. Shrager will be glad to personally review the CT scans (not the report only) and PFTs of potential patients who are candidates for LVRS prior to scheduling a patient visit. This information can be mailed to:

Dr. Joseph Shrager
Department of Cardiothoracic Surgery
Falk Building
870 Quarry Rd
Palo Alto, CA 94304
Telephone: 650-721-2086  

He will review these materials to determine the patient's initial candidacy for the operation, then arrange a patient visit if he thinks it is likely that he can help the patient with LVRS.

For patients who are not good candidates for surgical LVRS, we have an ongoing clinical trial of using stereotactic radiotherapy (sometimes called "SABR" or "Cyberknife") to create lung volume reduction.  We are studying this therapy, termed "SAVR"(stereotactic ablative volume reduction)  to determine whether it can have the same or similar benefits as surgical LVRS.

Stereotactic Ablative Lung Volume Reduction (SAVR) Clinical Trial

Many patients who might benefit from lung volume reduction surgery (LVRS) are not candidates for the surgery because they do not fit the criteria that we believe will allow a high probability of a good and safe outcome. For these patients, we have designed a clinical trial involving a new means of achieving a more minimally invasive "volume reduction" through the application of stereotactic radiotherapy (termed SAVR).

Stereotactic radiotherapy applies a strong, very localized beam of radiation to focal areas of the lung. This usually requires between one and three sessions of radiation. We have noted that when patients with lung cancer who could not tolerate surgery undergo stereotactic radiation as an alternative therapy for the tumor, a side-effect is often shrinkage of the radiated lobe of the lung. This finding has inspired us to try to use this "side-effect" of the radiation to help emphysema patients, using radiation therapy to shrink the most severely affected areas of the lung in a manner similar to the way lung volume reduction surgery allows us to remove the most diseased parts of the lung.

We have begun a clinical trial in which patients who are not good candidates for surgical LVRS can undergo SAVR. The first five patients will undergo SAVR only unilaterally (on one lung). If that proves to be safe, an additional five patients will undergo bilateral SAVR.

If you are interested in surgical LVRS, SAVR, or both, please call (650) 498-6000 and make an appointment to see Dr. Joseph Shrager. To have him pre-screen your studies before arranging a visit to Stanford, call (650) 721-2086.

Chest x-rays before and after LVRS

Typical areas of lung removed during LVRS

Intraoperative photo showing the stapling device used to remove the most abnormal, emphysematous lung tissue. 

Incision placement for the thoracoscopic (VATS) approach to the operation

The Division of Thoracic Surgery in the Department of Cardiothoracic Surgery at the Stanford School of Medicine is located in the San Francisco Bay Area in northern California. For more information about our services, please contact Donna Yoshida at (650) 721-2086 or Angela Lee, RN, MS, at (650) 721-5402. For new patient Thoracic Surgery Clinic Scheduling, please call (650) 498-6000.