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Evidence summaries

Lung Volume Reduction Surgery (LVRS) in Diffuse Emphysema

Short-term mortality is significantly greater but long-term mortality is lower in emphysema patients undergoing lung volume reduction surgery compared with usual care. Surgery may improve quality of life, exercise capacity and lung function in surviving patients. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 11 studies with a total of 1 760 subjects. One study accounted for 68% of the participants recruited. Short-term 90 day mortality was significantly greater in all those who underwent lung volume reduction surgery (LVRS), but long-term mortality favoured surgery (table T1). Participants with upper lobe-predominant emphysema and low baseline exercise capacity showed the most favourable outcomes related to mortality. Improvements in lung function, quality of life (SGRQ: St George's Respiratory Questionnaire) and exercise capacity were more likely with LVRS than with usual follow-up (table T1).

Lung volume reduction surgery for diffuse emphysema compared with standard medical care

OutcomeRelative effect(95% CI)Risk with controlRisk with intervention - surgery -(95% CI)No of participants(studies)
Early mortality (90 days)OR 6.16(3.22 to 11.79)13 / 100077 / 1000(42 to 138)1489(5)
Long-term mortality (> 36 months)OR 0.76(0.61 to 0.95)547 / 1000478 / 1000(424 to 534)1280(2)
Change in scores SGRQ (end of follow-up). A difference of 4 units is clinically important. The lower, the better-Mean SGRQ ranged from 57 units to 62.1 unitsMean SGRQ -13.78 units lower (-15.75 to -11.78)1326(2)
Walking distance (end of follow-up): 6-minute walking distance-Range 303 to 350 metresMean walking distance 0.70 standard deviations higher (0.42 to 0.98) - equates 70 metres215 (5)
FEV1 (end of follow-up)-Range 0.64 L to 0.7LMean FEV1 0.2 L higher (0.13 to 0.28)188 (4)

    References

    • van Agteren JE, Carson KV, Tiong LU et al. Lung volume reduction surgery for diffuse emphysema. Cochrane Database Syst Rev 2016;(10):CD001001. [PubMed]

Primary/Secondary Keywords