Lung volume reduction surgery is a proposed treatment for emphysema. Several groups have reported on the long-term benefits of LVRS in respect of sustained improvements in lung function tests, quality of life, exercise capacity and dyspnoea. Despite the above reports the duration of improvement varies within groups and the survival is not significantly different compared with medical treatment. The most representative study of LVRS is NETT, a randomized trial, which compared LVRS to continued medical treatment. The main conclusions from the NETT were the identification of a specific group with predominantly upper lobe emphysema and low baseline exercise capacity which benefits in the field of mortality compared to the other groups as well as to continued medical treatment. Patients with homogenous emphysema, low diffusion capacity and low FEV1 are at high risk of death following 30-90 days after LVRS. The main difficulties in evaluation of LVRS lie on the absence of identification of medical treatment and specifically the fact that, this procedure is not compared yet with the current treatment of COPD, which seems to be completely different from the one currently applied. Although there are some encouraging reports, LVRS is still an experimental palliative surgical procedure and several large randomized multicenter studies are needed to investigate the effectiveness and cost of LVRS in comparison to vigorous conventional therapy. Pneumon 2005, 18(2):156-162.