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Lung
Surgery for Emphysema Questioned
NEW
YORK (Reuters Health) - A costly but widely promoted surgery for
the lung disease emphysema does not help and may in fact be risky
for the sickest patients, according to the results of a large
federal study.
The procedure,
known as lung-volume-reduction surgery (LVRS), has in recent years
shown promise in treating emphysema. Typically, about 20% to 35%
of the diseased lung is removed. But doctors--and insurers--continue
to await longer-term trials of the strategy.
Now, early
results of the first large clinical trial aimed at evaluating
the efficacy of the surgery are available.
The study,
conducted by the National Emphysema Treatment Trial Research Group,
will be published in the October issue of The New England Journal
of Medicine. Editors at the journal released the study early because
they believe they findings are important.
``While the
findings tell us some benefits of the surgery, it tells us much
more about who should not receive the treatment,'' said study
co-author Dr. Robert Wise of Johns Hopkins University in Baltimore,
Maryland, in an interview with Reuters Health.
Specifically,
patients suffering from severe emphysema and who have severe injury
to blood vessels of the lung or who have the disease distributed
uniformly throughout their lung should not undergo the surgery,
Wise explained.
Between January
1998 and June 2001, 1,033 emphysema patients were randomly assigned
to two different groups. One group received LVRS. Patients in
the other group were given nonsurgical therapies. Surgeries were
conducted at 17 different medical centers throughout the US.
The report
indicates that 140 of the patients were classified as being at
high risk for death after surgery due to the fact that they had
the most severe disease. Half of these patients were assigned
to the surgery group, but one of them refused the procedure.
The high-risk
patients who underwent surgery were nearly four times more likely
to die than high-risk patients who received nonsurgical treatment,
the researchers report. Sixteen percent died within a month after
surgery.
``Some patients
who were disappointed when they discovered they were in the control
group can now be thankful that this assignment may have saved
their lives,'' Dr. Jeffrey M. Drazen writes in an accompanying
editorial.
``At this
time, it does not make any sense to use lung-volume-reduction
surgery in patients whose emphysema is so severe that they meet
these new exclusion criteria; indeed, in my opinion it does not
make sense for anyone to undergo lung-volume-reduction surgery
outside a controlled (clinical) trial,'' Drazen added.
Emphysema
is a chronic lung disease that most often strikes older adults
with a history of smoking. It causes an irreversible loss of the
lungs' elasticity, which results in an over-inflation in diseased
areas of the organs.
The idea behind
LVRS is that getting rid of these damaged parts of the lungs will
allow the remaining tissue to expand more fully and restore some
of the patient's breathing capacity. The concept is not new--having
been introduced in the 1950s--but it was largely abandoned until
research sparked renewed interest in it several years ago.
Other emphysema
treatments include exercise rehabilitation, inhalers, oxygen therapy
and, in some cases, lung transplantation. Experts say only a subset
of emphysema patients will benefit from LVRS, but the criteria
of the ideal candidates remain unclear.
About 1.8
million Americans suffer from emphysema, according to the American
Lung Association.
Reference
Source 89
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