Lung-volume reduction surgery an effective palliative for emphysema

Combined results of two controlled trials comparing lung-volume reduction surgery (LVRS) with optimal medical treatment show that the surgery is more effective in improving quality of life, dyspnea, pulmonary function and exercise tolerance in patients with emphysema.

Most published studies of LVRS have been too small to draw clear-cut conclusions, Dr. Robert L. Berger, at Harvard Medical School in Boston, and his associates note in the April issue of Chest. The large National Emphysema Treatment Trial still left unanswered questions, they add.The researchers therefore performed a meta-analysis of results from the Canadian Lung Volume Reduction surgery study and the Overholt-Blue Cross Emphysema Surgery Trial. Involved were 54 patients with advanced heterogeneous emphysema randomly assigned to LVRS after optimal medical therapy and 28 assigned to optimal medical therapy alone. Medical therapy included pulmonary rehabilitation, smoking cessation, yearly vaccination, oxygen therapy, and treatment with bronchodilators, corticosteroids and antibiotics. At the 6-month follow-up, mean FEV1 in the LVRS group had improved by 28.8%. Total lung capacity declined by 12.4% and residual volume by 24.3%. These values were significantly better than that at baseline. Changes were not significant in the medical therapy group.Mean 6-minute walking distance improved in the LVRS group by a significant 145.5 feet and declined in the medical therapy group by 57.9 feet. Quality of life scores on the chronic respiratory disease questionnaire and general health and physical functioning scoring also demonstrated better outcomes.Total 6-month mortality in the two groups was similar (5.7% in the LVRS group and 5.1% in the medical therapy group).Thus the researchers conclude that “continued questioning of the therapeutic value of LVRS is no longer relevant, and that the debate about utilization of LVRS should shift from the medical aspects to economic and ethical concerns.” In an accompanying editorial, Drs. Roger D. Yusen of Washington University School of Medicine, St. Louis and Benjamin Littenberg of the University of Vermont, Burlington note that the procedure does not appear to extend life in most patients, but can improve its quality.Clinicians, they conclude, “need to help patients to balance the considerable risks and costs of LVRS against the likely impacts on longevity, symptoms, functioning and other aspects of quality of life.” (Source: Chest 2005;127:1166-1177: Reuters Health: Oncolink: May 2005.)