TITLE

PREOPERATIVE PREDICTORS OF OUTCOME FOLLOWING LUNG VOLUME REDUCTION SURGERY

AUTHOR(S)
Sciurba, F. C.
PUB. DATE
October 2002
SOURCE
Thorax;Oct2002 Supplement 2, Vol. 57, pii47
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Lung-volume-reduction surgery is a proposed treatment for emphysema, but optimal selection criteria have not been defined. The National Emphysema Treatment Trial is a randomized, multicenter clinical trial comparing lung-volume-reduction surgery with medical treatment Methods: After evaluation and pulmonary rehabilitation, we randomly assigned patients to undergo lung-volume-reduction surgery or receive medical treatment Outcomes were monitored by an independent data and safety monitoring board. Results: A total of 1033 patients had been randomized by June 2001. For 69 patients who had a forced expiratory volume in one second (FEV1,) that was no more than 20% of their predicted value and either a homogeneous distribution of emphysema on computed tomography or a carbon monoxide diffusing capacity that was no more than 20% of their predicted value, the 30-day mortality rate after surgery was 16% (95% confidence interval, 8.2 to 26.7), as compared with a rate of 0% among 70 medically treated patients (p<0.001). Among these high-risk patients, the overall mortality rate was higher in surgical patients than medical patients (0.43 deaths per person-year vs. 0. 11 deaths per person-year; relative risk, 3.9; 95% confidence interval, 1.9 to 9.0). As compared with medically treated patients, survivors of surgery had small improvements at six months in the maximal work- load (p=0. 06), the distance walked in six minutes (p=0. 03), and FEV1 (p<0. 001), but a similar health-related quality of life. The results of the analysis of functional outcomes for all patients, which accounted for deaths and missing data, did not favor either treatment Conclusions: Caution is warranted in the use of lung-volume-reduction surgery in patients with emphysema who have a low FEV1 and either homogeneous emphysema or a very low carbon monoxide diffusing capacity. These patients are at high risk for death after surgery and also are unlikely to benefit from the surgery.
ACCESSION #
12915343

 

Related Articles

  • Lobar volume reduction surgery: a method of increasing the lung cancer resection rate in patients with emphysema. Edwards, J. G.; Duthie, D. J. R.; Waller, D. A. // Thorax;Oct2001, Vol. 56 Issue 10, p791 

    Background-Guidelines on patient selection for lung cancer resection identify a predicted postoperative forced expiratory volume in 1 second (ppoFEV1) of <40% as a predictor of high risk. Experience with lung volume reduction surgery suggests that ppoFEV1 may be underestimated in those with...

  • Methodologic issues in terminating enrollment of a subgroup of patients in a multicenter randomized trial. Lee, Shing M; Wise, Robert; Sternberg, Alice L; Tonascia, James; Piantadosi, Steven // Clinical Trials;2004, Vol. 1 Issue 3, p326 

    The National Emphysema Treatment Trial (NETT) was a multicenter randomized controlled trial comparing medical treatment plus lung-volume-reduction surgery (LVRS) to medical treatment alone for the treatment of severe emphysema. The primary outcomes specified for the trial were mortality from all...

  • Delayed Tracheal Rupture after Thyroidectomy. Alevizos, Leonidas; Tsamis, Dimitrios; Koutsoumanis, Konstantinos; Zografos, George // American Surgeon;Apr2012, Vol. 78 Issue 4, pE227 

    The article describes a case of delayed tracheal rupture after thyroidectomy in a 55-year-old woman. A subcutaneous emphysema was developed in the patient 40 days after the procedure caused by a delayed tracheal perforation. The patient experienced a feeling of swelling and distension without...

  • Computed Tomography-Based Centrilobular Emphysema Subtypes Relate with Pulmonary Function. Takahashi, Mamoru; Yamada, Gen; Koba, Hiroyuki; Takahashi, Hiroki // Open Respiratory Medicine Journal;2013, Vol. 7, p54 

    Introduction: Centrilobular emphysema (CLE) is recognized as low attenuation areas (LAA) with centrilobular pattern on high-resolution computed tomography (CT). However, several shapes of LAA are observed. Our preliminary study showed three types of LAA in CLE by CT-pathologic correlations. This...

  • Postmortem pulmonary CT in hypothermia. Schweitzer, Wolf; Thali, Michael; Giugni, Giannina; Winklhofer, Sebastian // Forensic Science, Medicine & Pathology;Dec2014, Vol. 10 Issue 4, p557 

    Fatal hypothermia has been associated with pulmonary edema. With postmortem full body computed tomography scanning (PMCT), the lungs can also be examined for CT attenuation. In fatal hypothermia cases low CT attenuation appeared to prevail in the lungs. We compared 14 cases of fatal hypothermia...

  • CT of pulmonary emphysema - current status, challenges, and future directions. Litmanovich, Diana; Boiselle, Phillip M.; Bankier, Alexander A. // European Radiology;Mar2009, Vol. 19 Issue 3, p537 

    Pulmonary emphysema is characterized by irreversible destruction of lung parenchyma. Emphysema is a major contributor to chronic obstructive pulmonary disease (COPD), which by itself is a major cause of morbidity and mortality in the western world. Computed tomography (CT) is an established...

  • Visual grading of emphysema severity in candidates for lung volume reduction surgery. Comparison between HRCT, spiral CT and "density-masked" images. Cederlund, K.; Bergstrand, L.; Högberg, S.; Rasmussen, E.; Svane, B.; Aspelin, P.; Cederlund, Kerstin; Högberg, S // Acta Radiologica;Jan2002, Vol. 43 Issue 1, p48 

    Purpose: To investigate which of three types of CT imaging yielded the best results in estimating the degree of emphysema in patients undergoing evaluation for lung volume reduction surgery (LVRS), whether there was any difference in this regard between the cranial and caudal part...

  • Extrathoracic proof of intrathoracic trouble. Dickhoff, C.; Hartemink, K. J.; Slebos, D. J.; Symersky, P.; Vonk-Noordegraaf, A. // Thorax;Aug2014, Vol. 69 Issue 8, p785 

    The article presents a case study of a 67-year-old man who was referred to the hospital for bullectomy where her chest computed tomography (CT) scan showed exhaustive bilateral bullous emphysema with a giant bulla in the right lung.

  • Design of the Endobronchial Valve for Emphysema Palliation Trial (VENT): a non-surgical method of lung volume reduction. Strange, Charlie; Herth, Felix J. F.; Kovitz, Kevin L.; McLennan, Geoffrey; Ernst, Armin; Goldin, Jonathan; Noppen, Marc; Criner, Gerard J.; Sciurba, Frank C. // BMC Pulmonary Medicine;2007, Vol. 7, p10 

    Background: Lung volume reduction surgery is effective at improving lung function, quality of life, and mortality in carefully selected individuals with advanced emphysema. Recently, less invasive bronchoscopic approaches have been designed to utilize these principles while avoiding the...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sign out of this library

Other Topics