The role of the multidisciplinary emphysema team meeting in the provision of lung volume reduction
Despite a positive result in favour of lung volume reduction surgery (LVRS), from one of the largest randomized controlled trial in thoracic surgery, the identification of poor outcome in certain high-risk groups has resulted in a worldwide decrease in its utilization. Patient selection is the key to successful lung volume reduction which, with the advent of a range of less invasive techniques, has become more complex. The greater variety of potential therapeutic options will inevitably lead to debate amongst treating clinicians. Therefore, to be able to make an informed decision on the best treatment for an individual patient, discussion between clinicians in a multidisciplinary team (MDT) meeting is advisable. The membership of this MDT must include all specialists involved in assessment and subsequent treatment of the patient including non-medical input. There must be robust administrative organization and record of decisions together with inter-disciplinary communication of decisions. Whilst ultimately it is the patient who will benefit from the MDT, individual participants will enhance their continued professional development. The referral pathway into the MDT must be clearly defined and disseminated. Which investigations are to be performed by referrers and which by the specialist centre need to be in an agreed protocol. Specialist input may be required to interpret the results of the latest assessment tools. The decision-making process of the MDT begins with confirmation of basic selection criteria but addresses three main areas of discussion: the definition of target areas of lung for reduction; the presence of collateral, interlobar ventilation and an assessment of individualized risk and benefit. The emphysema or lung volume reduction MDT has been established in several specialist units and its benefits include an increase in referrals overall for LVR. The establishment of an MDT approach to lung volume reduction has now been incorporated into several national guidelines.