A clinician's guide to the use of lung volume reduction surgery.
The primary purpose of the National Emphysema Treatment Trial (NETT) was to evaluate the clinical efficacy of lung volume reduction surgery (LVRS) compared with medical therapy as a treatment for advanced emphysema. Transitioning the results of a complex multicenter long-term clinical trial into routine clinical practice is challenging, particularly when the therapy examined is controversial, as was the case in NETT. Aspects of the "clinical art" used by the study investigators to select and treat patients are not always transparent to practitioners reading study publications. At the last NETT Steering Committee meeting, a roundtable discussion was held with investigators, coordinators, Steering Committee leadership, and Data Coordinating Center staff regarding the clinical aspects of patient evaluation and selection and performance of LVRS in advanced emphysema. The questions posed to the meeting participants were ones that are commonly asked by patients and their treating physicians who are considering LVRS and included the following: Why recommend LVRS to a patient? When should LVRS be recommended to a patient? What types of patients are candidates for LVRS? What are the important barriers to performing LVRS? What are the major messages delivered by NETT? It is hoped that answers from NETT investigators to some of these commonly encountered questions will provide clarity and guidance to clinicians faced with the responsibility of considering and discussing LVRS with their patients. NETT investigators were also queried regarding the future directions of research in emphysema and the role that NETT played in shaping that future. The following article is a summary of the highlights of these discussions.
Criner
Gerard J
GJ
Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA. crinerg@tuhs.temple.edu
Sternberg
Alice L
AL
D000465:Algorithms; D000075202:Contraindications; D003657:Decision Making; D006801:Humans; D015337:Multicenter Studies as Topic; D010043:Outcome and Process Assessment, Health Care; D018579:Patient Selection; D011013:Pneumonectomy; D011300:Preoperative Care; D011656:Pulmonary Emphysema / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D012129:Respiratory Function Tests