Details

Autor(en) / Beteiligte

• Naunheim, Keith S.
• Wood, Douglas E.
• Mohsenifar, Zab
• Sternberg, Alice L.
• Criner, Gerard J.
• DeCamp, Malcolm M.
• Deschamps, Claude C.
• Martinez, Fernando J.
• Sciurba, Frank C.
• Tonascia, James
• Fishman, Alfred P.

Titel

Long-Term Follow-Up of Patients Receiving Lung-Volume-Reduction Surgery Versus Medical Therapy for Severe Emphysema by the National Emphysema Treatment Trial Research Group

Ist Teil von

• The Annals of thoracic surgery, 2006-08, Vol.82 (2), p.431-443.e19

Ort / Verlag

Netherlands: Elsevier Inc

Erscheinungsjahr

2006

Quelle

MEDLINE

Beschreibungen/Notizen

• The National Emphysema Treatment Trial defined subgroups of patients with severe emphysema in whom lung-volume-reduction surgery (LVRS) improved survival and function at 2 years. Two additional years of follow-up provide valuable information regarding durability. A total of 1218 patients with severe emphysema were randomized to receive LVRS or medical treatment. We present updated analyses (4.3 versus 2.4 years median follow-up), including 40% more patients with functional measures 2 years after randomization. The intention-to-treat analysis of 1218 randomized patients demonstrates an overall survival advantage for LVRS, with a 5-year risk ratio (RR) for death of 0.86 ( p = 0.02). Improvement was more likely in the LVRS than in the medical group for maximal exercise through 3 years and for health-related quality of life (St. George’s Respiratory Questionnaire [SGRQ]) through 4 years. Updated comparisons of survival and functional improvement were consistent with initial results for four clinical subgroups of non-high-risk patients defined by upper-lobe predominance and exercise capacity. After LVRS, the upper-lobe patients with low exercise capacity demonstrated improved survival (5-year RR, 0.67; p = 0.003), exercise throughout 3 years ( p < 0.001), and symptoms (SGRQ) through 5 years ( p < 0.001 years 1 to 3, p = 0.01 year 5). Upper-lobe-predominant and high-exercise-capacity LVRS patients obtained no survival advantage but were likely to improve exercise capacity ( p < 0.01 years 1 to 3) and SGRQ ( p < 0.01 years 1 to 4). Effects of LVRS are durable, and it can be recommended for upper-lobe-predominant emphysema patients with low exercise capacity and should be considered for palliation in patients with upper-lobe emphysema and high exercise capacity.