Volume-reducing surgery for diffuse emphysema: effect of waiting with operation.
A Swedish study on Volume-reducing Surgery in diffuse Emphysema(EVRS)was performed during 1997 to 2000. Patients fulfilling strict criteria and having participated in a training program were randomized to either operation (Surgical Group, SG) or to continued training for one year (TG). After this year, patients in TG were offered surgery provided they were still fulfilling the criteria. 53 patients were randomized to each group, and the results showed a significant improvement in Health-related Quality of Life (QoL) and also lung function in the surgical group (Article in Press). In the TG, after the first year, surgery was performed in 32 patients. We compared the results with those who were operated in the SG.
The QoL and Lung function was the same in both SG and TG at start (Total Score St Georges Respiratory Questionnaire 59; SF-36 Physical function 22.2 and 22.9, respectively; FEV1 per cent predicted 26 and 27, respectively, and RV % predicted 255 and 267, respectively). There were large improvements in the SG in these figures after 3 and 6 months which then had a tendency to worsen again but at 1 year there were still significant differences between the groups. After surgery in the training group, these patients also improved, but no to the same extent as had those in the SG after their operation; and at two years after randomization, the patients in the SG and those in the TG who had been operated one year later had only non-significant differences both in QoL and lung function, but with a tendency to worse figures in the TG.
It seems that surgery should be performed early once the patient fulfills the criteria since this gives the patient a longer relief.
Of importance when deciding on operation or postponing possible surgery.
Gunnar Hillerdal, None.