Lung volume reduction surgery provides long-term benefits for emphysema patients

SEATTLE — Lung volume reduction surgery in patients with emphysema appeared to be safe and beneficial for overall survival 5 years after surgery, according to study findings presented at the American Association for Thoracic Surgery Annual Meeting.

Mark E. Ginsburg, MD, associate director of general thoracic surgery at Columbia University Medical Center, and colleagues conducted a retrospective analysis of 91 patients who consented to bilateral lung volume reduction surgery (LVRS) from January 2004 through June 2014 to assess its safety and efficacy for treating emphysema. Patients were part of the National Emphysema Treatment Trial. The primary outcomes were surgical mortality at 6 months and overall survival at 1, 2 and 5 years after LVRS.

Among 89 bilateral procedures, 88% were video-assisted thoracoscopic surgery; the remainder were median sternotomy. Two other surgeries were limited to a unilateral procedure.

There were no deaths at 6 months, and median survival was 9.1 years. Ginsburg and colleagues reported overall survival at 1 year (OR = 0.99; 95% CI, 0.96-1), 2 years (OR = 0.97; 95% CI, 0.93-1) and 5 years (OR = 0.78; 95% CI, 0.67-0.89).

“Long-term results demonstrate that LVRS is durable in many [emphysema] patients,” Ginsburg said during his presentation.

In secondary outcomes, forced expiratory volume in 1 second (percentage predicted) was 25.8 mL at baseline, which increased at 1 (40.3 mL), 2 (38.5 mL) and 5 years (36.2 mL). Maximal workload was 37.6 watts at baseline, and 49.1 watts, 44.4 watts and 45 watts at 1, 2 and 5 years, respectively.

Among 23 late deaths occurring at 10 months to 10 years after LVRS, 12 were attributed to respiratory failure.

“We believe bilateral LVRS can be performed with a negligible mortality risk using [video-assisted thoracoscopic surgery] techniques,” Ginsburg said. “These results represent the standard against which alternative methods of LVRS should be measured.” – by Ryan McDonald

Reference:

Ginsburg ME, et al. Abstract 104. Presented at: the American Association for Thoracic Surgery Annual Meeting; April 25-29, 2015; Seattle.

Disclosure: Ginsburg reports no relevant disclosures.