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Lung reduction surgery improves quality of life with emphysema

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Lung volume reduction surgery extends survival in patients with advanced emphysema and also improves quality of life, new research confirms.

“We found lung reduction surgery is a good treatment alternative for selected emphysema patients since it not only improves survival but also meaningfully improves quality of life for a period of at least 5 years after the operation,” lead author Dr. Roberto Benzo, from the Mayo Clinic, Rochester, Minnesota, said in a statement.

As noted, other studies have looked at the impact of lung volume reduction surgery on survival, but data regarding the effect on quality of life have been limited. Moreover, most studies that examined the quality of life have excluded patients who die during the study, “which tends to inflate the apparent benefits of interventions with a high risk of mortality,” the authors note.

Dr. Benzo’s team addressed this problem by looking at a composite endpoint consisting of death or a clinically meaningful decline in quality of life (8 points or greater drop in St. George’s Respiratory Questionnaire). The study group featured 1218 patients who were randomized to receive medical therapy or lung volume reduction surgery as part of the National Emphysema Treatment Trial (NETT).

The researchers report their findings in the American Journal of Respiratory and Critical Care Medicine for August 1.

The median time to reach the composite endpoint in the lung volume reduction surgery group was 2 years, significantly longer than the 1 year seen in the medical therapy group (p < 0.0001).

In terms of patient subgroups, lung volume reduction surgery yielded significant benefits for all patients without a high risk of perioperative death and for all with upper lobe predominant disease. The quality of life benefits with lung volume reduction surgery were most pronounced in the first 2 years after surgery.

“Our findings,” the authors conclude, “are relevant for recommending lung volume reduction surgery for patients with upper-lobe-predominant emphysema and in particular those with high exercise capacity, a subset of patients in whom the survival benefits may be marginal but in whom the combined survival and quality of life benefits are pronounced.”

Am J Respir Crit Care Med 2009;180:239-246.