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Lung volume reduction surgery for diffuse emphysemaTiong LU, Gibson PG, Hensley MJ, Hepworth R, Lasserson TJ, Smith B, Davies HRH R
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SummaryLung volume reduction surgery for adults suffering from diffuse emphysemaLung volume reduction surgery (LVRS) may help to make the lungs work more efficiently in oxygenating blood in people with emphysema. However, this procedure has been the centre of much controversy with its possible benefit being outweighed by harms and cost. This review of eight trials involving 1663 participants found that people undergoing LVRS ran an increased risk of death at three months post-operatively. By the end of follow up in the studies, there was no significant difference in mortality between surgery and non-surgically managed participants. Participants who were characterised by poor lung function and with a particular distribution of diseased tissue in their lungs were at a higher risk of death at three months and throughout one large study. The benefit of surgery in surviving patients was significant in terms of quality of life, exercise capacity and lung function.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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January 24. 2000 AbstractBackgroundLung volume reduction surgery (LVRS) has been re-introduced for treating patients with severe diffuse emphysema. It is a procedure that aims to improve long-term daily functioning, although it is costly and may also be associated with a high risk of mortality. ObjectivesTo assemble evidence from randomised controlled trials for the effectiveness of LVRS, and identify optimal surgical techniques. Search strategyRandomised controlled trials were identified using the Cochrane Airways Group Chronic Obstructive Pulmonary Disease (COPD) register. Searches are current to September 2008. Selection criteriaRandomised controlled trials that studied the safety and efficacy of LVRS in patients with diffuse emphysema were included. Studies were excluded if they investigated giant or bullous emphysema. Data collection and analysisTwo independent review authors assessed trials for inclusion and extracted data. Where possible, data from more than one study were combined using Review Manager software. Main resultsEight studies (1663 participants) met the entry criteria of the review. One study accounted for 73% of the participants recruited. Study quality was high, although blinding in studies was not possible. Ninety day mortality was significantly greater in all those who underwent LVRS (odds ratio 6.57 (95% CI 3.34 to 12.95), four studies, N = 1415). A subgroup analysis by risk status suggested that there was a subgroup of participants who were consistently at a significant risk of death, although this was only measured in one large study. The ninety day mortality data indicated that death was more likely with LVRS irrespective of risk status identified in one large study. Improvements in lung function, quality of life and exercise capacity were more likely with LVRS than with usual follow-up. Authors' conclusionsThe evidence summarised in this review is drawn from one large study, and several smaller trials. The findings from the large study indicated that in patients who survive up to three months post-surgery, there were significantly better health status and lung function outcomes in favour of surgery compared with usual medical care. Patients identified post hoc as being of high risk of death from surgery were those with particularly impaired lung function and poor diffusing capacity and/or homogenous emphysema. Further research should address the effect of this intervention on exacerbations and rate of decline in lung function and health status. |