Functional outcomes after bullectomy in Group III bullous emphysema: a single-center 24-month follow-up study

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Background: Bullous emphysema is a distinct form of chronic obstructive pulmonary disease (COPD), characterized by the presence of large air-filled spaces that compress adjacent lung parenchyma and impair ventilation. Surgical resection of bullae (bullectomy) aims to restore lung expansion and improve respiratory function. The objective of this study was to evaluate functional outcomes following bullectomy in patients with Group III bullous emphysema according to the De Vries and Wolf classification by assessing pulmonary function, exercise capacity, and postoperative complications during a 24-month follow-up period. Methods: This retrospective study included 38 patients who underwent bullectomy between 2008 and 2023. Demographic and clinical parameters, pulmonary function tests [forced vital capacity (FVC), forced expiratory volume in one second (FEV1), total lung capacity (TLC), residual volume (RV), diffusing capacity of the lung for carbon monoxide (DLCO)], 6-minute walk test (6MWT), and dyspnea score [modified Medical Research Council dyspnea scale (mMRC)] were assessed preoperatively and at 6, 12, and 24 months postoperatively. Postoperative complications were also recorded. Results: The mean patient age was 47 years. Active smokers accounted for 55.2% of the cohort. A statistically and clinically meaningful improvement was observed in FEV1, FVC, 6MWT, and mMRC scores at all postoperative time points (P<0.001), while TLC and RV showed significant reductions. The most common complication was prolonged air leak (39.4%), followed by cardiac arrhythmias (28.9%). No mortality was observed. Conclusions: Bullectomy was associated with significant improvements in functional parameters and quality of life during a 24-month follow-up period in carefully selected patients with Group III bullous emphysema.

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