Background Pulmonary emphysema is associated to cachexia and disregulation of the hormones regulating the glyco-lipidic metabolism, with insulin-resistance and altered substrate utilization. This study aimed at identifying the effects of lung-volume-reduction surgery (LVRS) on glyco-lipidic hormones compared to respiratory rehabilitation (RR). Methods Thirty-three patients with moderate-to-severe emphysema, undergoing video-assisted thoracoscopic LVRS, were compared to 31 similar patients, who refused operation and followed a standardized RR program. All patients were evaluated pre- and 12 months post-treatment for respiratory function, body composition, glyco-lipidic hormones, metabolic parameters and insulin-resistance, calculated using the homeostatic model assessment index (HOMA-IR). These groups were compared to a matched healthy control population. Results Only after LVRS, significant improvements were obtained in respiratory function (one-second forced expiratory volume +25.2%,p<0.0001; residual volume -19.5%,p<0.0001), metabolic parameters (total cholesterol +13.1%,p<0.01; high-density lipoprotein cholesterol +11.2%,p<0.01; triglycerids +18.4,p<0.001; not-esterified fatty acid -19.7%,p<0.001) and body composition (fat-free mass +6.5%,p<0.01; fat mass +11.9%,p<0.01). When corrected for fat mass, leptin (-6.1%,p<0.01) and resistin (-5.6%,p<0.01) decreased, whereas adiponectin (+6.9%,p<0.01) and GH-relin (+9.2%,p<0.01) increased, together with reduction of glycemia (-8.8%,p<0.01), insulin (-20.4%,p<0.001) and HOMA-IR (-27.2%,p<0.0001). Decrement of residual volume was correlated with increment of fat-free mass (rho=-0.49,p<0.02), fat mass (rho=-0.55,p<0.009), GH-relin (rho=-0.52,p<0.01), and also with decreases of leptin corrected for fat mass (rho=0.50,p<0.02), and marginally HOMA-IR (rho=0.35,p=0.07). Conclusions After LVRS, glyco-lipidic hormones and nutritional status significantly improved, with insulin-resistance reduction and more physiologic substrates utilization. Correlations between residual volume and body composition as well as glyco-lipidic hormones suggest that postoperative recovery in respiratory dynamics may induce favorable clinical changes when compared to RR.

Mineo D, Ambrogi V, Frasca L, Elena Cufari M, Pompeo E, Claudio Mineo T.