title: Recovery of body composition improves long-term outcomes after lung volume reduction surgery for emphysema.
abstract: Nutritional status deteriorates along with progression of emphysema, with the decline of body composition correlating with risk of disease-related events. Lung volume reduction surgery (LVRS), by improving respiratory function and recovering body composition, may influence long-term disease-related morbidity and mortality when compared to respiratory rehabilitation (RR). In this non-randomised study, 44 male patients with moderate-to-severe emphysema underwent LVRS, while 35 received RR. Respiratory parameters, body composition, number and time-to-occurrence of disease-related events were evaluated for 5 yrs. After LVRS, respiratory and nutritional parameters had significantly greater and longer lasting improvements than after RR. Disease-related events occurred later and less frequently after surgery than after rehabilitation, with better morbidity and mortality survival curves (p<0.01 and p<0.03, respectively). Body mass index (BMI) > or =23kg x m(-2), BODE (BMI, airflow obstruction, dyspnoea, exercise capacity) index < or =2 and fat-free mass index (FFMI) > or =16kg x m(-2) at 1 yr were the best positive predictors of post-operative outcomes (p<0.03, p<0.04 and p<0.005, respectively). Reduction in residual volume at 36 months after surgery was significantly correlated with the increase of BMI (rho = -0.56, p = 0.009) and FFMI (rho = -0.64, p = 0.001). LVRS significantly and durably improved respiratory function and body composition over RR. Relationships among residual volume, BMI, FFMI and disease-related events suggest that recovery in respiratory dynamics improves nutritional status, thus significantly reducing long-term disease-related morbidity and mortality.
authors.affiliation: Division of Thoracic Surgery, School of Medicine, Tor Vergata University of Rome, Viale Oxford 81, 00133 Rome, Italy. d.mineo@med.uniroma2.it
authors.forename: D
authors.initials: D
authors.lastname: Mineo
authors.forename: V
authors.initials: V
authors.lastname: Ambrogi
authors.forename: V
authors.initials: V
authors.lastname: Lauriola
authors.forename: E
authors.initials: E
authors.lastname: Pompeo
authors.forename: T C
authors.initials: TC
authors.lastname: Mineo
mesh_terms: D000368:Aged; D001784:Blood Gas Analysis; D001823:Body Composition; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011013:Pneumonectomy / Q000379:methods*; D011656:Pulmonary Emphysema / Q000601:surgery* / Q000628:therapy*; D012044:Regression Analysis; D012119:Respiration; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D013256:Steroids