The results of two studies that compared the results of surgery to remove lung tissue, known as lung volume reduction surgery (LVRS), with that of medical treatment show that surgery is more effective in improving quality of life, breathing and mobility in patients with advanced emphysema.

Most published studies of LVRS have been too small to draw clear-cut conclusions, Dr. Robert L. Berger, at Harvard Medical School in Boston, and his associates note in the medical journal Chest. To investigate, they performed a review of the results from the Canadian Lung Volume Reduction surgery study and the Overholt-Blue Cross Emphysema Surgery Trial.

Fifty-four patients with advanced emphysema were randomly assigned to undergo LVRS after they had received medical treatment and 28 patients were assigned to receive medical therapy alone. Medical therapy included pulmonary rehabilitation, smoking cessation, yearly vaccination, oxygen therapy, and drug treatment with bronchodilators, corticosteroids and antibiotics.

At the six-month follow-up, lung function test results improved in the LVRS group, and were significantly better than that at baseline. No significant changes were seen in the medical therapy group.

Physical functioning test results also improved significantly in the LVRS group, but declined in the medical therapy.

Quality of life scores on the chronic respiratory disease questionnaire and general health and physical functioning scoring also demonstrated better outcomes in patients who had undergone surgery.

However, 6-month mortality rates in the two groups were similar (5.7 percent in the LVRS group and 5.1 percent in the medical therapy group).

The researchers conclude that “continued questioning of the therapeutic value of LVRS is no longer relevant, and that the debate about utilization of LVRS should shift from the medical aspects to economic and ethical concerns.”

In an accompanying editorial, Drs. Roger D. Yusen of Washington University School of Medicine, St. Louis and Benjamin Littenberg of the University of Vermont, Burlington, note that the procedure does not appear to extend life in most patients, but can improve its quality.

They conclude that doctors “need to help patients to balance the considerable risks and costs of LVRS against the likely impacts on longevity, symptoms, functioning and other aspects of quality of life.”

SOURCE: Chest, April 2005.