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Lung volume reduction surgery improves outcomes in advanced emphysema

Among patients with end-stage emphysema, lung volume reduction surgery was associated with significant improvements in clinical and quality-of-life outcomes at 1 year after treatment, researchers reported in the Annals of Thoracic Surgery.

Specifically, from baseline to 1 year, there were mean increases of 46% in forced vital capacity (FEV; P .0001), 43% in forced expiratory volume in 1 second (FEV₁; P .0001), 16% in diffusing capacity of the lungs for carbon monoxide (P .0001) and 20% in 6-minute walk distance (P = .0001). These increases were accompanied by a 23% decrease in residual volume (P .0001).

Effect sizes for improvement indicated a clinically meaningful response, according to the data.

Using the SF-36, the researchers also assessed quality of life. After surgery, 89% of patients had improvement in physical functioning, 68% reported decreased role limitations due to physical health, 34% reported decreased role limitations due to emotional health, 78% had increased vitality, 64% had improvements in overall mental health, 61% noted improvement in social functioning, 34% had reduced bodily pain, and 69% reported better general health than before surgery. Of these, improvements in physical functioning, role limitations due to physical health and vitality were statistically significant.

Changes in quality of life also positively correlated with clinical outcomes; however, the correlations were not strong enough to act as surrogates for pulmonary function testing, as the researchers had hypothesized.

In a subgroup analysis, results showed that patients with predominantly heterogeneous disease, defined as low upper lung zone function, based on ventilation/perfusion scans had a greater increase in FEV₁ than those with more homogenous distribution, defined as high upper lung zone function (54% vs. 19%). There was also a negative correlation between increasingly homogenous disease and the percent change in FEV₁.

Similarly, quality-of-life improvements tended to be larger in patients with heterogeneous disease vs. homogenous disease.

“An important point to reiterate is that while patients with heterogeneous disease see greater improvements, those with homogenous disease who are hyperinflated also see significant improvements in objective and subjective measures making them appropriate for evaluation for this procedure,” the researchers wrote.

The retrospective chart review included data from 123 patients undergoing lung volume reduction surgery at Southern Illinois University School of Medicine at Memorial Medical Hospital in Springfield from 2007 to 2015. Twenty patients were excluded due to death within the first year after surgery or due to missing data, leaving 93 patients for the final analysis. The mean age of patients was 65.6 years, 59% were men and 97% were white.

The study was limited by inconsistent follow-up and the lack of a control group of patients on medical therapy alone, according to the researchers. Nevertheless, they noted that these data demonstrate that lung volume reduction surgery significantly benefits certain patients and that the center plans to evaluate longitudinal outcomes at 3 and 5 years after surgery.

In the meantime, the researchers emphasized the need to optimize patient selection criteria and increase awareness among physicians that lung volume reduction surgery is an option for patients with severe chronic obstructive pulmonary disease. – by Melissa Foster

Disclosure: Healio Pulmonology could not confirm relevant financial disclosures at the time of publication.