OBJECTIVE We analyzed the overall results with our lung volume reduction surgery (LVRS) program, which entailed unilateral and bilateral LVRS, selectively performed on the basis of precise clinical and radiologic morphology criteria. METHODS Between 1995 and 2005, 182 patients were operated on unilaterally (104 patients) or bilaterally (78 patients). Amongst bilateral procedures, 39 patients were operated in one-stage fashion and 39 in a staged fashion. RESULTS Overall 90-day mortality was 2.8% (4 patients). Mean follow-up was 51 +/- 30 months. Six months absolute improvement in forced expiratory volume in one second (FEV1) was 0.27 +/- 0.2L in the unilateral group, 0.38 +/- 0.2L in the staged bilateral group, and 0.45 +/- 0.2L in the one-stage group. Residual volume decrease were 1.1 +/- 0.5L, 0.99 +/- 0.3L, and 1.75 +/- 0.5L in the unilateral, staged bilateral and one stage bilateral groups, respectively. Overall, improvements in FEV1 occurred for up to 36 months in the unilateral group and for up to 48 months in the bilateral group. Residual volume remained improved for up to 72 months in the unilateral and staged bilateral groups, and for up to 48 months in the one-stage group. The SF-36 health-related quality of life physical functioning domain score remained improved for more than 48 months in all groups and for up to 72 months in the staged group only. Five-year survival were 78%, 88% and 77%, in the unilateral, staged bilateral and one-stage bilateral groups, respectively. CONCLUSIONS We conclude that highly satisfactory long-term survival and long lasting clinical improvements occurred in patients undergoing unilateral or bilateral LVRS.