title: Long-term follow-up of patients receiving lung-volume-reduction surgery versus medical therapy for severe emphysema by the National Emphysema Treatment Trial Research Group.
abstract: BACKGROUND
  The National Emphysema Treatment Trial defined subgroups of patients with severe emphysema in whom lung-volume-reduction surgery (LVRS) improved survival and function at 2 years. Two additional years of follow-up provide valuable information regarding durability.
  
  
  METHODS
  A total of 1218 patients with severe emphysema were randomized to receive LVRS or medical treatment. We present updated analyses (4.3 versus 2.4 years median follow-up), including 40% more patients with functional measures 2 years after randomization.
  
  
  RESULTS
  The intention-to-treat analysis of 1218 randomized patients demonstrates an overall survival advantage for LVRS, with a 5-year risk ratio (RR) for death of 0.86 (p = 0.02). Improvement was more likely in the LVRS than in the medical group for maximal exercise through 3 years and for health-related quality of life (St. George's Respiratory Questionnaire [SGRQ]) through 4 years. Updated comparisons of survival and functional improvement were consistent with initial results for four clinical subgroups of non-high-risk patients defined by upper-lobe predominance and exercise capacity. After LVRS, the upper-lobe patients with low exercise capacity demonstrated improved survival (5-year RR, 0.67; p = 0.003), exercise throughout 3 years (p < 0.001), and symptoms (SGRQ) through 5 years (p < 0.001 years 1 to 3, p = 0.01 year 5). Upper-lobe-predominant and high-exercise-capacity LVRS patients obtained no survival advantage but were likely to improve exercise capacity (p < 0.01 years 1 to 3) and SGRQ (p < 0.01 years 1 to 4).
  
  
  CONCLUSIONS
  Effects of LVRS are durable, and it can be recommended for upper-lobe-predominant emphysema patients with low exercise capacity and should be considered for palliation in patients with upper-lobe emphysema and high exercise capacity.
authors.affiliation: St. Louis University, 3635 Vista Blvd, St. Louis, MO 63110-0250, USA. naunheim@slu.edu
authors.forename: Keith S
authors.initials: KS
authors.lastname: Naunheim
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Wood
authors.forename: Zab
authors.initials: Z
authors.lastname: Mohsenifar
authors.forename: Alice L
authors.initials: AL
authors.lastname: Sternberg
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Criner
authors.forename: Malcolm M
authors.initials: MM
authors.lastname: DeCamp
authors.forename: Claude C
authors.initials: CC
authors.lastname: Deschamps
authors.forename: Fernando J
authors.initials: FJ
authors.lastname: Martinez
authors.forename: Frank C
authors.initials: FC
authors.lastname: Sciurba
authors.forename: James
authors.initials: J
authors.lastname: Tonascia
authors.forename: Alfred P
authors.initials: AP
authors.lastname: Fishman
mesh_terms: D000368:Aged; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011656:Pulmonary Emphysema / Q000401:mortality / Q000523:psychology / Q000601:surgery*; D011788:Quality of Life; D016896:Treatment Outcome