Many emphysema patients could benefit from surgery

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - A type of operation called lung volume reduction surgery (LVRS) can provide lasting benefits for people with emphysema, including improvements in exercise ability, quality of life, and survival, according to study findings presented at the annual meeting of the Society of Thoracic Surgeons in Chicago.

Emphysema, a disease closely associated with smoking, involves the destruction of the tiny air sacs in the lungs where oxygen is exchanged for carbon dioxide. LVRS works by removing the diseased portions of the lung, making the whole organ function better.

LVRS, however, is not for everyone with emphysema. People with disease in the upper portions of the lung who have low exercise capacity seem to glean the most benefit from the operation.

"LVRS kind of fell off everybody's radar in 1995 when Medicare stopped reimbursing for the procedure because they felt the risks and benefits were unclear," lead author Dr. Keith Naunheim told Reuters Health. "We began a multicenter study to address these issues and now Medicare reimburses for lung volume reduction surgery -- but for 7 years, the only place you could get it was at one of the study centers. So, a lot of people forgot about it."

In 2003, the 2-year results of the study came out, showing that LVRS is better than standard medical therapy in improving survival, exercise capacity, and quality of life in certain subgroups of emphysema patients. "But these findings seemed to fall on deaf ears," Naunheim, from St. Louis University School of Medicine, said.

"Last year, Medicare paid for just 254 patients to undergo LVRS," suggesting that primary care physicians are largely unaware of this surgery as an option for their emphysema patients, Naunheim said.

In the updated study, 5-year data for 1218 patients were available for analysis. The benefits observed at the 2-year mark were largely still present at 5 years, the report indicates.

The findings confirmed that upper lobe disease was most responsive to surgery and went on to show that a low exercise capacity was predictive of the greatest improvements. Conversely, patients with widespread disease or disease in the lower portions of the lungs and a higher exercise capacity did the worst and probably should not undergo the operation, Naunheim said.

Naunheim hopes that this study will raise awareness of LVRS as a treatment option for emphysema, adding that "up to 20 percent of emphysema patients may be candidates for LVRS."