Mixed Findings on Emphysema Surgery

A long-term, 17-center trial on the safety and effectiveness of lung volume reduction surgery to treat advanced emphysema has demonstrated that although the operation provided significant improvements in some patients, some others did not benefit and some even had a higher mortality rate as a result of the operation. The trial was sponsored by the US National Heart, Lung, and Blood Institute. The results were reported in the May 20, 2003, issue of The New England Journal of Medicine.

The trial involved 1,218 patients with severe emphysema and ran from January 1998 through July 2002. All patients underwent pulmonary rehabilitation and were randomized to receive lung volume reduction surgery or continued medical treatment. The study showed that an operation provides some emphysema patients with a significant improvement in pulmonary function, exercise tolerance, quality of life, and survival, compared to medical treatment.

However, very little difference was found in overall mortality rates, although there was a clear survival advantage for patients who had both upper-lobe predominant emphysema and low baseline exercise capacity after rehabilitation. This group had the greatest chance of realizing functional improvements from surgery, compared to medical treatment. Among patients whose emphysema was not confined to the upper lobes and who had high exercise capacity after rehabilitation, surgery patients had a higher mortality rate and little chance of long-term exercise improvement.

"Careful evaluation helps to identify which patients benefit from the operation,” said principal investigator Robert J. McKenna, Jr., M.D., head of thoracic surgery at the Lung Center of Cedars-Sinai Medical Center (Los Angeles, CA, USA). "The most important factor for the selection of patients is the pattern of emphysema on computed tomography (CT) and exercise capacity.”




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