Optimizing Lung Volume Reduction Surgery, with Charles Bakhos, MD, MBA, MS

In an interview with HCPLive at the 2025 Global Initiative for Chronic Obstructive Lung Disease (GOLD) International COPD Conference in Philadelphia, PA, this week, Charles Bakhos, MD, MBA, MS, professor of thoracic medicine and surgery at Lewis Katz School of Medicine at Temple University, helped characterize patients who most frequently require lung volume reduction surgery (LVRS) due to failing bronchoscopic lung volume reduction (BLVR).

Generally, these patients are presenting with severe emphysema and respiratory failure and require oxygen dependence after frequent COPD exacerbations.

“On average, they have few options for quality-of-life and improvements and improving their survival rate — so that’s where we come with the principle of the intervention, in trying to remove unhealthy lung tissue or get it out of the equation,” Bakhos said. “You’re talking about trying to give more room for the healthier lung, to have the patient potentially come off oxygen, improve their quality of life, and be able to perform their daily activities.”

A common hurdle toward initiating lung volume reduction surgery is in addressing a historical stigma associated with the now low-risk procedure. Bakhos explained that early stages of LVRS in the 1950s were linked to significant risk of complications and mortality due to a lack of technology.

“It was reinvigorated in the 1990s and a subsequent randomized trial showed its benefit, but it showed its benefit in a particular group of patients: those who have their emphysema, mostly in the upper lung zone area, and those who are, I would say sick enough — but not too sick and not healthy enough, because you would want the risk-benefit ratio to work to your advantage and their advantage,” Bakhos explained.

Eligible patients who reach Bakhos’ clinic have passed multiple screenings ranging from imaging to pulmonary physiologic testing. A key criteria for procedure is patients agreeing to undergo pulmonary rehabilitation before and after surgery.

“It gives us an idea about their compliance and whether they can stick to a program where they are basically assigned to go to rehab once, twice or three times a week,” Bakhos said. “It gives us an idea about their stamina. And it does improve their energy level and their muscle function. It can help them gain some weight, and, again, improve their overall conditioning prior to a rather higher than average-risk surgery.”

For clinicians who are looking to adopt more refined LVRS practices, Bakhos emphasized a multi-disciplinary approach. He highlighted his Temple team’s structuring to ensure patients are never even leaving the same floor as their pulmonologist for their surgery referral.

“I would strongly focus on the collaborative efforts between pulmonary and thoracic,” Bakhos said. “We also work very closely with our radiologists. We have advanced imaging technology now that we're able to use that does help us with patient selection for surgery and even in the operating room, it does help us quite a bit in targeting the most emphysematous area of the lung and go after it in order to get the best outcomes possible.”