Lung Volume-Reduction Surgery Helps Emphysema Patients

Researchers at the Mayo Clinic (Rochester, MN, USA) followed 1,218 patients with severe emphysema enrolled in U.S. National Emphysema Treatment Trial (NETT), and randomized them to either undergo LVRS or nonsurgical medical treatment, which generally consisted of customized use of medication, oxygen support, smoking cessation, and pulmonary rehabilitation. Six hundred eight patients underwent LVRS, and 610 received standard medical care; the patients were then followed for five years or until they died. All endpoints except death were measured at six-month intervals. The primary outcome was a composite endpoint consisting of death or an unquestionable and meaningful deterioration in quality of life.

The researchers found that the average time until a composite event (either death or a serious decline in quality of life) was one year for medically treated patients, and two years for patients who had undergone LVRS. Patients whose emphysema was predominantly found in the upper lobes of their lungs (65%) also showed quality of life and survival benefits greater than survival benefits alone, suggesting that they lived longer and better. The researchers cautioned, however, that LVRS has a small but inherent danger of perioperative mortality. The results of the study were published in the August 1, 2009, issue of the American Journal of Respiratory and Critical Care Medicine.

"We found lung reduction surgery is good treatment alternative for selected emphysema patients since it not only improves survival but also meaningfully improves quality of life for a period of at least five years after the operation,” said lead author Roberto Benzo, M.D., M.Sc. "Patients who underwent LVRS, with the exception of those who had non-upper-lobe-predominant emphysema, had both a survival and quality of life benefit when compared to similar patients undergoing medical treatment only.”

LVRS consists of removing a portion of emphysematous lung tissue in the patient, since severe emphysema causes an effect called air trapping, where the patient can inhale, but is unable to force the air back out of the lung. While removing lung tissue in patients whose breathing is compromised may seem counterintuitive, emphysematous lung tissue is actually one of the main causes of shortness of breath in patients with emphysema.

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