Chronic Obstructive Lung Disease - Surgical Procedures

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Prognosis. Two-year results of the largest study to date, called the National Emphysema Treatment Trial (NETT), indicate that patients who are good candidates for LVRS achieve better lung function with surgery, and have no higher risk of death, than those on medical therapy. Mortality rates within 90 days of surgery are almost 8% compared to about 1% in patients on medical therapy. However, in spite of the early spike in deaths after surgery, there are no overall differences in long-term survival rates.

When the operation is successful, patients report significant improvement in walking distance, weight, and quality of life. Many patients can engage in active daily events, such as golf or stair-climbing, without oxygen. Even in carefully selected candidates, however, about 15% of patients derive little or no benefit from the procedure, and about 4% get worse. Furthermore, even in successful cases, the improvement is most notable within the first 6 months, after which the condition progresses again. Beyond 2 years, lung function deteriorates to the same level as it was before the procedure. It is not clear yet if surgery is cost effective over time, compared to medical therapy.

Possible Candidates. For now, the procedure is used only in people who have severe emphysema and not chronic bronchitis. And it is applicable only to a minority of these patients. Appropriate candidates are those with the following characteristics:

• Under 75 years old
• Having severe obstruction (FEV1 less than 40% but higher than 20% of expected value)
• Carbon monoxide diffusing capacity of more than 20% of expected value
• Hyperinflated lungs (total lung capacity greater than 120% of the expected value)
• Appropriate candidates who have deficiency of alpha 1-antitrypsin, even if they have disease in the lower lobe, may do well

The most recent NETT results indicate that surgical patients who had emphysema in the upper lungs, and a low exercise capacity, may have better survival rates and outcome than the same patient group who is given medical therapy.