The National Emphysema Treatment Trial (NETT) found that lung volume reduction surgery (LVRS) improves survival, exercise capacity, and quality-of-life in a subset of patients with severe emphysema. We report our experience with LVRS following publication of the NETT.
We prospectively collected demographic and clinical data of patients referred for LVRS. All evaluations were performed according to NETT protocols. The Wilcoxon signed-rank test was used to compare paired continuous variables.
We evaluated 115 patients for LVRS between January 1, 2004 and April 29, 2005 (Figure). Fifteen patients (13%) underwent LVRS after completing pulmonary rehabilitation. The average age was 62.9 ± 5.1 years and 7 (47%) were male. All 15 patients had upper lobe predominant emphysema and met NETT inclusion criteria. Six (40%) had low exercise capacity and 9 (60%) had high exercise capacity, as defined by the NETT. Seven underwent video-assisted thoracoscopic surgery and 8 underwent median sternotomy. No deaths occurred during the study period. Median intensive care unit (ICU) and hospital lengths of stay (LOS) were 2 (interquartile range 2-3) and 9 (interquartile range 7-9.5) days, respectively. Postoperative complications included prolonged air leak (>7 days) in 6 of 15 (40%) and 1 each of blood transfusion > 2 units, arrhythmia, and Clostridium difficile diarrhea. Seven patients have returned for 6 month follow-up; no patient was lost to follow-up. Pulmonary function, exercise capacity, Medical Research Council dyspnea score, and the BODE index improved significantly compared to post-rehabilitation values (Table). Three (43%) had an improvement in maximal exercise capacity of >10 Watts.
Utilizing NETT criteria no mortality was seen. Complications and hospital and ICU LOS were minimal. Improvements in the BODE index, lung function, exercise capacity, and dyspnea can be achieved with LVRS in patients with severe upper lobe emphysema. Larger studies should determine if decrements in the BODE index predict improved survival.
LVRS improves BODE index, a predictor of mortality in patients with COPD. Utilizing NETT criteria may minimize mortality and morbidity in patients undergoing LVRS.
David Lederer, None.Table—
Six Month Outcomes After Lung Volume Reduction SurgeryVariablePre-LVRS*Post-LVRSp ValueBODE index5.7 ± 1.42.9 ± 1.70.02FVC % predicted52.7 ± 1269.6 ± 180.03FEV1 % predicted27.9 ± 737.1 ± 130.02TLC % predicted114.3 ± 1199.6 ± 130.02DLCO % predicted26.1 ± 1129.4 ± 110.46PaO2, mm Hg63.3 ± 1368.7 ± 110.15Maximal workload during CPET, Watts34 ± 1546 ±150.03Distance walked in 6 minutes, meters374 ± 48431 ± 630.02MRC Dyspnea score2.7 ± 1.40.7 ± 0.80.03*
Data are mean ± standard deviation.