title: Lung volume reduction surgery using the NETT selection criteria.
abstract: BACKGROUND
  The National Emphysema Treatment Trial (NETT) proved that lung volume reduction surgery (LVRS) was safe and effective in patients with certain clinical characteristics and using defined inclusion-exclusion criteria. Based on the selection criteria developed in that trial, we performed bilateral LVRS on 49 patients during the period of February 2004 until May 2009.
  
  
  METHODS
  Forty-nine patients underwent lung volume reduction by either median sternotomy (10) or video-assisted thoracoscopic surgery (39) selected according to NETT described parameters. Preoperative characteristics were the following: mean (±SD) age 62.5±6.6 years, preoperative FEV1 (forced expiratory volume in the first second of expiration) 691 cc (±159), % of predicted FEV1 25.3 (±6.2), preoperative Dlco (diffusing capacity of lung for carbon monoxide) 7.6 (±2.7), and % of predicted DLCO 27% (±7.3). All patients had upper lobe predominant disease and either low exercise capacity (n=23) or high exercise capacity (n=26) as defined by the NETT.
  
  
  RESULTS
  There was no operative or 90-day mortality. Median length of stay was 8 days (interquartile range=6 to 10). Two patients required reintubation and tracheostomy but were decannulated prior to discharge. The BODE index (body mass index, airflow obstruction, dyspnea, and exercise capacity), a multidimensional predictor of survival in chronic obstructive pulmonary disease, improved -2.3 (±1.5, p<0.0001) (missing data: 5 of 42, 11.9%) and the FEV1 improved 286 cc (±221, p<0.0001), both 1 year after surgery. Probability of survival was 0.98 (95% CI [confidence interval]=0.94 to 1) at 1 year, and 0.95 (95% CI=0.88 to 1) at 3 years.
  
  
  CONCLUSIONS
  Surgical lung volume reduction for emphysema can be performed in patients using selection criteria developed by the NETT with very low surgical risk and excellent midterm results. Surgical LVRS is the standard against which other nonsurgical treatments for advanced emphysema should be judged.
authors: Department of Surgery, Columbia University College of Physicians and Surgeons, Medical Center, New York, New York 10032, USA. meg18@columbia.edu
authors: Mark E
authors: ME
authors: Ginsburg
authors: Byron M
authors: BM
authors: Thomashow
authors: Chun K
authors: CK
authors: Yip
authors: Angela M
authors: AM
authors: DiMango
authors: Roger A
authors: RA
authors: Maxfield
authors: Matthew N
authors: MN
authors: Bartels
authors: Patricia
authors: P
authors: Jellen
authors: William A
authors: WA
authors: Bulman
authors: David
authors: D
authors: Lederer
authors: Francis L
authors: FL
authors: Brogan
authors: Lyall A
authors: LA
authors: Gorenstein
authors: Joshua R
authors: JR
authors: Sonett
mesh_terms: D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000503:physiopathology; D018579:Patient Selection; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011656:Pulmonary Emphysema / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D056346:Sternotomy / Q000379:methods*; D016019:Survival Analysis; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome