HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Keith S. Naunheim Douglas E. Wood Malcolm M. DeCamp Claude C. Deschamps Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Naunheim, K. S. Articles by Fishman, A. P. Search for Related Content PubMed PubMed Citation Articles by Naunheim, K. S. Articles by Fishman, A. P. Related Collections Lung - other Related Article

Ann Thorac Surg 2006;82:431-443
© 2006 The Society of Thoracic Surgeons

---

J. Maxwell Chamberlain Memorial Paper for General Thoracic Surgery

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

Accepted for publication May 11, 2006.

^_* Address correspondence to Dr Naunheim, St. Louis University, 3635 Vista Blvd, St. Louis, MO 63110–0250. (Email: naunheim{at}slu.edu).

Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006. Winner of the J. Maxwell Chamberlain Memorial Award for General Thoracic Surgery.

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.

Related Article

Will Lung Volume Reduction Surgery Be Widely Applied?

Claude Lenfant
Ann. Thorac. Surg. 2006 82: 385-387. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				G. J. Criner and A. L. Sternberg National Emphysema Treatment Trial: The Major Outcomes of Lung Volume Reduction Surgery in Severe Emphysema Proceedings of the ATS, May 1, 2008; 5(4): 393 - 405. [Abstract] [Full Text] [PDF]

				M. M. DeCamp Jr., D. Lipson, M. Krasna, O. A. Minai, R. J. McKenna Jr., and B. M. Thomashow The Evaluation and Preparation of the Patient for Lung Volume Reduction Surgery Proceedings of the ATS, May 1, 2008; 5(4): 427 - 431. [Abstract] [Full Text] [PDF]

				M. M. DeCamp Jr., R. J. McKenna Jr., C. C. Deschamps, and M. J. Krasna Lung Volume Reduction Surgery: Technique, Operative Mortality, and Morbidity Proceedings of the ATS, May 1, 2008; 5(4): 442 - 446. [Abstract] [Full Text] [PDF]

				N. Patel, M. DeCamp, and G. J. Criner Lung Transplantation and Lung Volume Reduction Surgery versus Transplantation in Chronic Obstructive Pulmonary Disease Proceedings of the ATS, May 1, 2008; 5(4): 447 - 453. [Abstract] [Full Text] [PDF]

				E. P. Ingenito, D. E. Wood, and J. P. Utz Bronchoscopic Lung Volume Reduction in Severe Emphysema Proceedings of the ATS, May 1, 2008; 5(4): 454 - 460. [Abstract] [Full Text] [PDF]

				G. J. Criner, A. L. Sternberg, and for the National Emphysema Treatment Trial Researc A Clinician's Guide to the Use of Lung Volume Reduction Surgery Proceedings of the ATS, May 1, 2008; 5(4): 461 - 467. [Abstract] [Full Text] [PDF]

				O. A. Minai, J. Benditt, and F. J. Martinez Natural History of Emphysema Proceedings of the ATS, May 1, 2008; 5(4): 468 - 474. [Abstract] [Full Text] [PDF]

				P. Vaughan, I. F. Oey, M. C. Steiner, M. D.L. Morgan, and D. A. Waller A prospective analysis of the inter-relationship between lung volume reduction surgery and body mass index Eur. J. Cardiothorac. Surg., December 1, 2007; 32(6): 839 - 842. [Abstract] [Full Text] [PDF]

				E. Pompeo and T. C. Mineo Two-Year Improvement in Multidimensional Body Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity Index After Nonresectional Lung Volume Reduction Surgery in Awake Patients Ann. Thorac. Surg., December 1, 2007; 84(6): 1862 - 1869. [Abstract] [Full Text] [PDF]

				G. Tino, L. B. Ware, and M. Moss Clinical Year in Review IV: Chronic Obstructive Pulmonary Disease, Nonpulmonary Critical Care, Diagnostic Imaging, and Mycobacterial Disease Proceedings of the ATS, September 15, 2007; 4(6): 494 - 498. [Full Text] [PDF]

				K. F. Rabe, S. Hurd, A. Anzueto, P. J. Barnes, S. A. Buist, P. Calverley, Y. Fukuchi, C. Jenkins, R. Rodriguez-Roisin, C. van Weel, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: GOLD Executive Summary Am. J. Respir. Crit. Care Med., September 15, 2007; 176(6): 532 - 555. [Abstract] [Full Text] [PDF]

				G. Varela, A. Brunelli, G. Rocco, M. F. Jimenez, M. Salati, and T. Gatani Evidence of Lower Alteration of Expiratory Volume in Patients With Airflow Limitation in the Immediate Period After Lobectomy Ann. Thorac. Surg., August 1, 2007; 84(2): 417 - 422. [Abstract] [Full Text] [PDF]

				A. E Martin-Ucar, K. R Fareed, A. Nakas, P. Vaughan, J. G Edwards, and D. A Waller Is the initial feasibility of lobectomy for stage I non-small cell lung cancer in severe heterogeneous emphysema justified by long-term survival? Thorax, July 1, 2007; 62(7): 577 - 580. [Abstract] [Full Text] [PDF]

				K. F. Rabe, B. Beghe, F. Luppi, and L. M. Fabbri Update in Chronic Obstructive Pulmonary Disease 2006 Am. J. Respir. Crit. Care Med., June 15, 2007; 175(12): 1222 - 1232. [Full Text] [PDF]

				H. O. Coxson Computed tomography and monitoring of emphysema Eur. Respir. J., June 1, 2007; 29(6): 1075 - 1077. [Full Text] [PDF]

				B. M. Trotta, A. V. Stolin, M. B. Williams, S. B. Gay, A. S. Brody, and T. A. Altes Characterization of the Relation Between CT Technical Parameters and Accuracy of Quantification of Lung Attenuation on Quantitative Chest CT Am. J. Roentgenol., June 1, 2007; 188(6): 1683 - 1690. [Abstract] [Full Text] [PDF]

				C. Lenfant Will Lung Volume Reduction Surgery Be Widely Applied? Ann. Thorac. Surg., August 1, 2006; 82(2): 385 - 387. [Full Text] [PDF]