Lung volume reduction surgery (LVRS) is a well-established surgical intervention aimed at improving pulmonary function and quality of life in carefully selected patients with severe emphysema. By resecting the most diseased, hyperinflated portions of the lung—typically in an upper-lobe predominant distribution—LVRS enhances diaphragmatic mechanics and reduces dynamic hyperinflation, resulting in improved ventilatory efficiency. Patient selection is critical and will be reviewed here. Data from the National Emphysema Treatment Trial (NETT) have demonstrated that, in appropriately selected patients, LVRS can lead to significant gains in exercise tolerance, symptom burden, and even survival. Despite its benefits, the procedure carries substantial perioperative risks, including prolonged air leak and respiratory complications, underscoring the importance of multidisciplinary evaluation and comprehensive preoperative optimization. LVRS remains an important therapeutic option for patients with advanced emphysema who are refractory to medical management.