A recent paper suggests that lung-volume--reduction surgery, believed to be a potentially valuable treatment for advanced emphysema, may be dangerous for some patients. The operation involves the resection of 20-35% of the emphysematous lung, by means of either a median sternotomy or video-assisted thorascopy. Generally, lung function, exercise capacity and quality of life improve after surgery, but results have been shown to vary.
The National Emphysema Treatment Trial is a randomized, multicentre trial comparing lung-volume--reduction surgery with medical treatment. The study found that, for patients with emphysema who have a low forced expiratory volume in one second (FEV1) and either a homogeneous emphysema or a very low carbon dioxide diffusing capacity, the 30-day mortality rate after surgery was 16%. This mortality rate was in comparison to a rate of 0% among 70 medically treated patients.
The main goal of the trial is to compare survival rates and exercise capacity two years after lung-volume--reduction surgery with the results obtained after medical treatment. Another important goal of the trial is to identify selection criteria for the surgery. As a result of the findings of this study, the National Emphysema Treatment Trial has now modified its protocol to exclude this particular group of patients.
- National Emphysema Treatment Trial Research Group. Patients at high risk of death after lung-volume--reduction surgery. New England Journal of Medicine. From the website http://content.nejm.org/, to be published in the October 11 issue.