Reducing Lung Volume--is it worth the risk

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.


  1. 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, to be published in the October 11 issue.