Thursday, 7 July, 2022
HomePulmonologyAdoption of LVRS for emphysema urged

Adoption of LVRS for emphysema urged

Emphysema is a chronic, progressive, obstructive lung disease in which the small sacs of the lung (alveoli) are destroyed, leading to air pockets and severe breathing difficulties. In 2011, 4.7m Americans reported being diagnosed with emphysema, and in 2013 more than 8,200 patients died from emphysema.

While traditionally emphysema has been treated medically, a surgical option, lung volume reduction surgery (LVRS), was introduced in 1993. LVRS removes diseased portions of the lung and allows the expansion of remaining, still-functional lung tissue. In 2003, the National Emphysema Treatment Trial (NETT) validated the efficacy of LVRS in improving survival and function in selected patients with severe emphysema.

"Despite these results, adoption of LVRS in the US for the treatment of severe emphysema has been exceedingly poor," said Dr Mark E Ginsburg, associate professor of surgery, division of cardiac, vascular, and thoracic surgery at Columbia University Medical Centre. Possible reasons cited for poor utilisation are the perceived magnitude of the procedure, perceived high surgical mortality and morbidity, ill-defined patient selection criteria, inconsistent and unpredictable benefits, and lack of proven durability.

At the American Association for Thoracic Surgery (AATS) Annual Meeting this year, Ginsburg presented the results of 10 years of experience with LVRS for emphysema, covering the period between 2004 and 2014. The study clearly demonstrated that LVRS can be performed with negligible surgical mortality risk using minimally invasive surgical techniques. No patients died within six months of LVRS and the overall survival for the group was 0.99 at 1 year, 0.97 at 2 years, and 0.78 at 5 years. Ginsburg noted "improvements in airflow, exercise capacity, and dyspnea were relatively stable for five years."

"Surgical LVRS remains the gold standard against which all other forms of lung volume reduction must be judged. Surgical LVRS should be more widely offered to patients with advanced emphysema who meet CMS selection criteria," concluded Ginsburg.

[link url=""]Columbia University material[/link]
[link url=""]AATS 2015 abstract[/link]

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