There is no cure for emphysema. Palliation of symptoms is the focus of medical management. In 1995, lung volume reduction surgery (LVRS) was reintroduced as a surgical treatment for symptomatic patients with emphysema and marked lung hyperinflation. Although improved QOL is the primary objective of treatment, few surgical reports utilize specific QOL measures. We present early results from the CLVR Trial with a focus on several QOL outcomes at 3 and 6 months.
Risk (surgical mortality and hospital length of stay) and QOL assessment (Chronic respiratory questionnaire (CRDQ), short form 36 (SF-36), SF-36 Utility and quality adjusted life days(QALDs)) are the outcomes presented from the CLVR trial comparing LVR surgery with rehabilitation and best medical therapy.
In the CLVR, 58 patients were randomized (30 surgical, 28 medical). There were no 30-days postoperative deaths. The 6-month mortality was 3.6% in the surgical arm and 5% in the medical arm. Median length of hospital stay was 22 days. Patients experienced clinically important and statistically significant improvements in each domain of the CRDQ at 3 and 6 months. Domains of physical functioning in SF-36 were remarkably improved: Physical functioning improved by 25.9 (95%CI 14, 37.5; p<0.001). SF-36 Utility also demonstrated an improvement at 3 months 0.07, (p=0.08) and 0.10 (p=0.13) at 6 months. A gain of 16 QALDs was achieved by 6 months.CONCLUSIONS: LVR surgery requires a lengthy and often difficult hospitalization. Clinically important and statistically significant improvements in QOL are observed at three and six months following LVR.
LVRS, with disclosure of surgical risks, should be offered to all suitable patients with moderate to severe emphysema who seek palliation of their symptoms. We await longer term results with interest.
J.D. Miller, The Canadian Institute of Health Research, grant monies.