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Low Mortality and Favourable Outcome in Lung Volume Reduction Surgery for Different Emphysema Mo

Single-centre study shows low 30-day mortality and meaningful functional improvements after LVRS across various emphysema morphologies, with outcomes sustained up to 3 years.

GIST

Background A quarter of a century after the National Emphysema Treatment Trial (NETT), lung volume reduction surgery (LVRS) remains an underused procedure with the notion of high mortality and morbidity, mainly recommended for upper lobe predominant heterogeneous emphysema. With advances in patient selection, minimally invasive surgery and improved recovery, this perception may be outdated. This study evaluates 5-year single-centre outcome, including patients beyond traditional NETT criteria (non-upper lobe and non-heterogeneous morphology). Methods This prospective study included all consecutive LVRS procedures (August 2019 to July 2024). Surgical, functional and quality of life outcomes (COPD Assessment Test (CAT) and St George's Respiratory Questionnaire (SGRQ)) were analysed at 3 and 6 months, and then annually up to 3 years. Subanalysis compared markedly versus non-markedly heterogeneous morphology and isolated versus non-isolated upper lobe disease.

Clinical Editorial

A definitive appraisal of LVRS across diverse emphysema morphologies Context and study design: - This single-centre, prospective cohort evaluates five-year outcomes of lung volume reduction surgery (LVRS) performed August 2019 through July 2024. - All consecutive LVRS procedures were included, extending beyond the traditional National Emphysema Treatment Trial (NETT) criteria to encompass non-upper lobe and non-heterogeneous disease. - Outcomes encompassed surgical metrics, functional status, and health-related quality of life, with assessments at 3 and 6 months and annually up to 3 years. Patient-reported outcomes included the COPD Assessment Test (CAT) and St George’s Respiratory Questionnaire (SGRQ). Population and baseline characteristics: - The cohort comprised 191 patients undergoing 223 LVRS procedures. - Baseline median and interquartile range values showed severe airflow limitation and hyperinflation: FEV1 at 31% predicted (range 27–37%), residual volume at 219% predicted (203–250%), six-minute walk distance (6MWD) at 358 m (291–439). - Symptom burden and quality of life were substantial, with CAT at 22 (18–25) and SGRQ at 62 (48–71). Intervention and perioperative outcomes: - 30-day mortality was 0.5% (n=1), indicating very low short-term mortality in this experienced centre. - Median hospital stay was 7 days (interquartile range 4–10). - Prolonged air leak occurred in 17.9% of cases, and postoperative infection in 2.2%. Efficacy signals over time: - Among those evaluated at 3 years (n=42 of 191), objective and patient-reported measures showed significant improvement: - FEV1 rose to 38% predicted (29–48%). - RV decreased to 173% predicted (148–199%). - CAT score improved to 20 (17–24). - SGRQ score improved to 55 (39–68). - These changes were statistically significant, indicating meaningful clinical benefit in this extended population. Morphology-specific observations: - Marked morphology was non-markedly heterogeneous in 57.6%, and non-isolated upper lobe disease was present in 56%. - No significant differences in morbidity were observed between morphology subgroups, suggesting consistent safety across these phenotypes within this specialised setting. Interpretation and limitations: - The authors conclude that LVRS in a specialised centre yields exceptionally low mortality and morbidity with meaningful functional and QoL gains, supporting broader use beyond classic NETT criteria.

Original source: http://erj.ersjournals.com/cgi/content/short/67/4/2501133?rss=1