February 3, 2006

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

"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

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."