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.
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.
Naunheim
Keith S
KS
St. Louis University, 3635 Vista Blvd, St. Louis, MO 63110-0250, USA. naunheim@slu.edu
Wood
Douglas E
DE
Mohsenifar
Zab
Z
Sternberg
Alice L
AL
Criner
Gerard J
GJ
DeCamp
Malcolm M
MM
Deschamps
Claude C
CC
Martinez
Fernando J
FJ
Sciurba
Frank C
FC
Tonascia
James
J
Fishman
Alfred P
AP
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