Lung volume reduction surgery (LVRS) is a palliative procedure proposed for a selected minority of patients with severe emphysema. Resection of portions of nonfunctional peripheral lung can increase elastic recoil, thereby enhancing expiratory flows and reducing hyperinflation. The postoperative reduction in hyperinflation decreases the load on the respiratory muscles and increases their strength. Despite a purported decrease in dyspnea and improvements in exercise tolerance and quality of life, a substantial number of patients do not show improvements in expiratory flows or gas exchange after surgery. Moreover, the rate of decline in forced expiratory volume in one second and the mortality rate after surgery do not necessarily compare favorably with those reported in patients who do not undergo surgery. Consequently, LVRS should be considered an investigational procedure in the management of patients with severe emphysema. Large multicenter randomized trials currently underway in the US and Europe should help define appropriate patient selection criteria and may clarify short-term and long-term outcomes associated with LVRS.