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Ann Thorac Surg 2001;72:327-329
© 2001 The Society of Thoracic Surgeons

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Editorial

The National Emphysema Treatment Trial: a paradigm for future surgical trials

^a Section of General Thoracic Surgery, University of Washington, Seattle, Washington, USA
^b Division of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA

Address reprint requests to Dr Wood, Division of Cardiothoracic Surgery, University of Washington, Box 356310, 1959 NE Pacific, AA-115, Seattle, WA 98195-6310
e-mail: dewood@u.washington.edu

Over the past century, a variety of surgical procedures have been proposed to improve the symptoms and quality of life in patients with severe emphysema. Costochondrectomy and thoracoplasty were performed in an attempt to alter the configuration of the chest cavity, and phrenic nerve ablation or induced pneumoperitoneum were attempted to restore the curvature of the diaphragm. Improvement of pulmonary blood flow was the intent of pleurodesis, and there were other techniques of airway stenting or autonomic denervation [1]. Each of these procedures enjoyed a period of popularity, at least among their surgical champions, who believed firmly, yet wrongly, that their intervention provided some benefit to patients with severe emphysema. The history of surgeryhas many such procedures that were initially popular and promoted in the absence of sound scientific data, only to wither under more rigorous examination. With the benefit of historical and scientific perspective, as academic thoracic surgeons we should anticipate these criticisms of our innovations and answer them with scientifically sound confirmation or disproof of new surgical hypotheses.

Doctor Otto Brantigan described the techniques and physiologic principles underlying what is now known as lung volume reduction surgery (LVRS). [2] The modern experience with LVRS was first described by Dr Joel Cooper and his colleagues. The Washington University group reported their first 20 LVRS patients with an objective improvement in forced expiratory volume in 1 second (FEV₁) of 82% [3].

When one examines the initial seven publications on LVRS, totaling 738 patients, the results are encouraging. The improvement in FEV₁ averaged 61%, the 6-minute walk increased 46%, and there was a 62% rate of liberation from oxygen dependence. These results were accompanied by an improvement in dyspnea scale and quality of life, at a cost of 2.5% to 10% operative mortality and an 11- to 17-day . . . [Full Text of this Article]

This article has been cited by other articles:

				S. D. Ramsey and S. D. Sullivan Evidence, Economics, And Emphysema: Medicare's Long Journey With Lung Volume Reduction Surgery Health Aff., January 1, 2005; 24(1): 55 - 66. [Abstract] [Full Text] [PDF]