Departments: Interventional Pulmonology in Other Journals
A Prospective Evaluation of Lung Volume Reduction LVRS in 200 Consecutive Patients
Chest. 2003;123:1026–1037. Yusen RD, Lefrak SS, Gierada DS, Davis GE, Meyers BF, Patterson GA, Cooper JD. Division of Pulmonary, Washington University School of Medicine, St. Louis, MO.
The primary objectives of this prospective cohort study were to assess long-term health-related quality of life, satisfaction, physiological status, and survival of the first 200 patients after bilateral lung volume reduction surgery (LVRS). Each patient served as his own control, initially receiving optimal medical therapy (MT) pulmonary rehabilitation before undergoing LVRS. The patient population described in this study is the same as the group discussed in the previous paper. The only difference is that this paper had 50 fewer patients. Much of the data in this report appears similar to the information in the previous paper by the same group of authors. The follow-up period of these 200 patients was a mean of 3.7 ± 1.6 years (median, 4.0 y). Follow up at 6 months, 3 years, and 5 years after surgery showed that the dyspnea scores were improved in 81%, 52%, and 40% of patients, respectively. Dyspnea scores were the same or improved in 96% (6 mo), 82% (3 y), and 74% (5 y) of patients. Improvements in SF-36 physical functioning were demonstrated in 93% (6 mo), 78% (3 y), and 69% (5 y) of patients. Good-to-excellent satisfaction with the outcomes was reported by 96% (6 mo), 89% (3 y), and 77% (5 y) of patients. The FEV1 was improved in 92% (6 mo), 72% (3 y), and 58% (5 y) of patients. Changes in dyspnea and general health-related quality-of-life scores, and patient satisfaction scores were all significantly correlated with changes in FEV1. After surgery, the median length of hospital stay in survivors was 9 days. The 90-day postoperative mortality was 4.5%. Annual Kaplan-Meier survival through 5 years after surgery was 93%, 88%, 83%, 74%, and 63%, respectively. During follow up, 15 patients underwent subsequent lung transplantation. The authors conclude that in stringently selected patients, LVRS resulted in substantial beneficial effects over and above those achieved with optimized medical therapy. The duration of improvement was at least 5 years in the majority of survivors. These conclusions are similar to the conclusions from the paper described previously (the same first 200 patients from this study were part of the report discussed previously). This report demonstrates that bilateral LVRS, in carefully selected patients with severe emphysema, produces significant and prolonged improvements in dyspnea and general health-related quality of life.