UW News

May 29, 2003

Results mixed in lung surgery study

Results of the largest study of bilateral lung volume reduction surgery (LVRS) to treat severe emphysema indicate that, on average, patients who undergo LVRS with medical therapy are more likely to function better after two years and do not face an increased risk of death compared to those who receive medical therapy only.

UW Medical Center was one of the sites for the National Emphysema Treatment Trial (NETT), a five-year, multicenter, randomized study that evaluated the effectiveness and safety of adding LVRS to medical therapy with pulmonary rehabilitation for patients with advanced emphysema.

The effects of LVRS varied widely among patients, however. Researchers, including Drs. Douglas Wood in the UW Department of Surgery and Joshua Benditt in the Department of Medicine, identified two characteristics that helped predict the outcome of the surgery for individual patients: the distribution of emphysema — that is, whether the damage was concentrated in the upper areas of the lungs — and the patient’s exercise capacity.

Patients whose emphysema was predominantly in the upper lobes of the lung and whose exercise capacity was low after pulmonary rehabilitation were more likely to survive longer and function better after LVRS, compared to similar patients who received medical therapy only.

The findings were presented last week at the American Thoracic Society 99th International Conference in Seattle, and printed in the May 22 edition of the New England Journal of Medicine.

NETT researchers at 17 clinical sites, including UWMC, studied survival, exercise ability, lung function, quality-of-life scores, shortness of breath, and illness and hospitalization rates of 1,218 patients with severe emphysema for an average follow-up of 29 months. At the start of the study, all participants received six to 10 weeks of pulmonary rehabilitation, which included education, counseling, exercise training, and other techniques to help patients understand and manage their condition, and optimize their ability to perform activities of daily living. The participants were then randomly divided into two groups: 608 patients were selected to receive surgery in addition to medical therapy, and 610 continued receiving medical therapy only.

NETT investigators, led by Dr. Scott Ramsey, associate professor of medicine at the UW, also conducted a prospective cost-effectiveness analysis over three years of follow-up as part of the trial. They found that in the short term, LVRS added to medical therapy was less cost effective than many surgical procedures, in part because of high costs related to the procedure. Whether LVRS will prove cost effective over the long term remains uncertain.