Lung Reduction Surgery Too Risky for Some

Lung-volume–reduction surgery has been touted as a treatment for emphysema, but recent evidence from the National Emphysema Treatment Trial indicates that there is an increased chance of death in many patients who undergo this treatment. Based on a research sample of 1033 patients who had FEV1 readings of no more than 20% of the predicted value, the 30 day mortality rate was 16% compared with a 0% rate for patients treated with non-surgical medical methods.

It also indicated that those patients who did survive did not show any significant benefits from the surgery, compared with those who did not elect to have surgery for their lung condition. Quality of life between surgical and non-surgical patients indicated that the surgical patients did not show an increased quality of life. Non-surgical patients, however did not show an increased quality of life either, but their risk of death was significantly lower. The researchers identified a high risk group of patients who should not have the lung - volume-reduction surgery due to the lack of benefits and increased mortality rate. These patients included those with extremely low FEV1, a homogeneous pattern of emphysema, and a high perfusion ratio. These characteristics seem to be accurate predictors of an increased risk of overall mortality. Additionally, a low FEV1 and a low carbon monoxide diffusing capacity were directly related to the 30-day mortality rate statistics.

In the high risk group, the cause of death was identified as respiratory in 90% in the surgery group and 89 percent in the traditional treatment group. Sixty percent of surgical patients and 43 percent of traditional patients were on ventilators at the time of death. Among those high risk patients, over 30% developed pneumonia within 30 days of their surgery, which eventually contributed to the higher mortality rate.

The impact of this research was considered so significant by the New England Journal of Medicine that they issued an early report on the findings, prior to publication of the study in their print version. The impact has also been recognized by the National Emphysema Treatment Trial. As a result of the study, they no longer enroll such patients in their clinical trials, and warn physicians that caution should be used in performing lung-volume–reduction surgery in such patients.

To quote the findings of the National Emphysema Treatment Trial, "Caution is warranted in the use of lung-volume–reduction surgery in patients with emphysema who have a low FEV1 and either homogeneous emphysema or a very low carbon monoxide diffusing capacity. These patients are at high risk for death after surgery and also are unlikely to benefit from the surgery."

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