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 volum
e +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.