Lung-volume reduction surgery is a good option for many patients with end-stage emphysema

Feb 21 2006

Tens of thousands of Americans living with emphysema would benefit from a surgical procedure that removes part of the lung, according to national research presented by a Saint Louis University cardiothoracic surgeon.

The findings confirm earlier study results and offer new hope to select patients, says Keith Naunheim, M.D., director of the division of cardiothoracic surgery at Saint Louis University School of Medicine and principal investigator of the eight-year long National Emphysema Treatment Trial.

"This validates the early results reported in 2003 - the surgery is still a bad idea for some patients, but it is still a good idea for other patients," says Naunheim, who presents his findings at the 42nd Society of Thoracic Surgeons Annual Meeting in Chicago.

"We now know the improvements resulting from lung-volume reduction surgery last longer in some patients. This is an operation we should strongly be recommending for many patients with end-stage emphysema."

Lung-volume reduction surgery is a procedure that removes up to a third of the diseased portion of the lung.

The study examined mortality rates, ability to exercise and quality of life of patients who had undergone lung-volume reduction surgery after two years and up to five years, Naunheim said.

Five years after undergoing lung volume reduction, those with emphysema in the upper lobes of their lungs showed improvement in survival, exercise and quality of life when compared to patients who were treated with standard medical therapy. These findings are consistent with those researchers saw after the two-year mark and demonstrate that the benefit from the operation is durable. Of the 1,218 patients enrolled in the national emphysema study, 24 percent had higher survival rates after to the lung surgery and 58 percent were in a group that demonstrated improved exercise and quality of life.

Naunheim says he was slightly surprised by how well the upper-lobe emphysema patients with a lower ability to exercise did after the surgery in comparison to similar patients in the study who did not undergo surgery.

"Based on our earlier findings, we knew those with upper-lobe emphysema would see some improvement," Naunheim says. "We now know (the low exercise group) saw the most improvement in ability to exercise and in quality of life."

The low-exercise group saw more improvement than the high-exercise group "because they had more room for improvement," Naunheim says.

Those who did worst after the surgery had emphysema distributed throughout the lungs and/or in the lower portion of their lungs and had higher exercise capacities.

"Based on these results, we would not recommend these patients undergo lung-volume reduction," Naunheim says, noting that those patients didn't experience improvements in any of the three areas.

The study is the first of its kind to examine the safety and efficacy of lung-volume reduction surgery on a nation-wide basis. It was also the first time that the National Institutes of Health teamed with the Centers for Medicare and Medicaid Services in 1996 to organize a national study. For this emphysema trial, patients with severe emphysema at 17 clinical sites were randomly divided into two groups: one underwent lung volume reduction surgery while the other received medical therapy only.