Effect of lung-volume-reduction surgery in patients with severe emphysema.

Background: Although many patients with severe emphysema have undergone lun g-volume-reduction surgery, the benefits are uncertain. We conducted a rand omized, controlled trial of the surgery in patients with emphysema. Patient s with isolated bullae were excluded because such patients are known to imp rove after bullectomy. Methods: Potentially eligible patients were given intensive medical treatme nt and completed a smoking-cessation program and a six-week outpatient reha bilitation program before random assignment to surgery or continued medical treatment. After 15 patients had been randomized, the entry criteria were modified to exclude patients with a carbon monoxide gas-transfer value less than 30 percent of the predicted value or a shuttle-walking distance of le ss than 150 m, because of the deaths of 5 such patients (3 treated surgical ly and 2 treated medically). Results: Of the 174 subjects who were initially assessed, 24 were randomly assigned to continued medical treatment and 24 to surgery. At base line in both groups, the median forced expiratory volume in one second (FEV1) was 0 .75 liter, and the median shuttle-walking distance was 215 m. Five patients in the surgical group (21 percent) and three patients in the medical group (12 percent) died (P=0.43). After six months, the median FEV1) had increas ed by 70 ml in the surgical group and decreased by 80 ml in the medical gro up (P=0.02). The median shuttle-walking distance increased by 50 m in the s urgical group and decreased by 20 m in the medical group (P=0.02). There we re similar changes on a quality-of-life scale and similar changes at 12 mon ths of follow-up. Five of the 19 surviving patients in the surgical group h ad no benefit from the treatment. Conclusions: In selected patients with severe emphysema, lung-volume-reduct ion surgery can improve FEV1, walking distance, and quality of life. Whethe r it reduces mortality is uncertain. (N Engl J Med 2000;343:239-45.) (C) 20 00, Massachusetts Medical Society.