Lung Volume Reduction Surgery Helpful in COPD

Laurie Barclay, MD

April 08, 2003

April 8, 2003 -- Lung volume reduction surgery (LVRS) is beneficial for chronic obstructive pulmonary disease (COPD), according to the results of a prospective cohort study published in the April issue of Chest. In this five-year study of stringently selected patients, the procedure improved outcome over and above optimal medical therapy.

Although short-term studies have yielded conflicting results, long-term studies, including one reported in the March issue of the Journal of Thoracic and Cardiovascular Surgery, seem to support the use of this procedure. The editorialists in Chest agree that this type of treatment has long-term benefit.

"Once patients develop severe emphysema, quality of life is compromised by marked shortness of breath and difficulty in performing everyday tasks. With standard medical therapy, nearly half of these patients will die within three to five years," lead author Roger D. Yusen, MD, MPH, FCCP, from Washington University School of Medicine in St. Louis, Missouri, says in a news release. "Ours is the largest long-term study showing that LVRS changes the natural progression of the disease, improving lung function and quality of life in the majority of survivors through five years after surgery."

From 1993 to 1998, 200 patients with disabling dyspnea due to marked airflow obstruction, thoracic hyperinflation, and heterogeneously distributed emphysema had bilateral LVRS and were followed for five years. Each patient served as his own control, initially receiving optimal medical management including exercise rehabilitation before LVRS.

Ninety-day postoperative mortality was 4.5%. Survival was 93% at one year after surgery, 88% at two years, 83% at three years, 74% at four years, and 63% at five years. During follow-up, 15 patients had lung transplantation.

Dyspnea scores improved in 81% of patients in the first six months, and were better or no worse than before surgery in 82% at three years after surgery and in 74% at five years after surgery. Scores for perceived physical functioning improved significantly in 93% at six months, in 78% at three years, and in 69% at five years after surgery.

The FEV 1 improved in 92% of patients at six months, with sustained improvement in 72% at three years and in 58% at five years. After LVRS, exercise capacity increased and requirements for supplemental oxygen decreased. At six months, 96% reported good to excellent overall satisfaction with the surgery compared with 89% at three years and 77% at five years.

Study limitations include patient enrollment from a single center and some missing follow-up data.

"The results of this study are long-awaited and quite impressive. Previous LVRS studies publishing long-term data pale by comparison," says editorialist Arthur F. Gelb, MD, FCCP, from the University of California, Los Angeles, School of Medicine. "The findings in this study should help to reinstate Medicare reimbursement for LVRS in patients with severe emphysema with good surgical potential in whom there are no therapeutic alternatives."

Dr. Yusen is a consultant for Spiration, Inc. Senior author Joel D. Cooper, MD, FCCP, receives a royalty from Biovascular, Inc., for his development of the Peristrip staple-line reinforcement.

Chest. 2003;123:975-977, 1026-1037

Reviewed by Gary D. Vogin, MD

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