The National Emphysema Treatment Trial showed a 30 day mortality of 16% after lung-volume-reduction surgery in high risk patients with emphysema and forced expiratory volume in one second and either carbon monoxide diffusing capacity no more than 20 per cent of their predicted value or homogenous emphysema on computed tomography. There was no mortality in medically treated patients. Seven of 90 patients treated for emphysema with lung-volume-reduction surgery at the Karolinska Hospital in Stockholm had a reduced lung function according to these criteria. Two of the high risk patients (29%) died within one month of the operation compared to two of the remaining 83 patients (2%). Lung-volume-reduction surgery is not a therapeutic option for patients with emphysema and a severely reduced lung capacity but can be performed with a low risk to alleviated symptoms and improve the functional capacity if localised areas for the surgical resection can be identified.