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Clinical InvestigationsCOPDA Prospective Evaluation of Lung Volume Reduction Surgery in 200 Consecutive Patients
Section snippets
Design
A prospective cohort study design was used to assess the initial 200 patients undergoing bilateral LVRS since the inception of our program. Operative dates ranged from 1993 through 1998. The study follow-up ended in 2000. Given the variable duration of follow-up based on operation dates, we chose to analyze and report the results for three discrete postoperative follow-up time points: closest to 6 months after surgery, closest to 3 years after surgery, and closest to 5 years after surgery. The
Patient Selection
Study patients were accrued through review of approximately 3,000 sets of patient records obtained through mailed correspondence (from 1992 to 1997). Based on an audit of the records, approximately two thirds of the patients were not invited for an on-site evaluation predominantly because of insufficient heterogeneity of emphysema or insufficient impairment. Of the 517 patients evaluated on-site during the study recruitment, 206 patients (40%) were accepted for bilateral LVRS, 41 patients (8%)
Discussion
Patients with severe emphysema seek relief of dyspnea, improved functioning, and better quality of life from LVRS. Studies of LVRS limited to short-term follow-up have demonstrated improvements in physiologic measurements following surgery.5678910111213141516171819202122 A smaller number of short-term studies evaluating dyspnea and patient-perceived PF have also demonstrated improvements in these parameters after LVRS, but most studies have emphasized the assessment of physiologic parameters.
ACKNOWLEDGMENT
The results of our LVRS program depend on the assistance of a team of professionals. We thank the cardiothoracic anesthesia staff; the nursing services of the cardiothoracic operating room, the postoperative recovery area, and thoracic surgical units; the physical therapy (chest physiotherapy) and respiratory therapy departments; Dottie Biggar, RN, and the staff of the pulmonary rehabilitation program; Ms. Mary Vogel for assistance with patient follow-up; Mary Pohl, RN, Tracey Guthrie, RN, and
References (50)
- et al.
Bilateral pneumectomy (volume reduction) for chronic obstructive pulmonary disease
Thorac Cardiovasc Surg
(1995) - et al.
Unilateral thoracoscopic surgical approach for diffuse emphysema
Thorac Cardiovasc Surg
(1996) - et al.
Should lung volume reduction surgery for emphysema be unilateral or bilateral?
Thorac Cardiovasc Surg
(1996) - et al.
Dyspnea response following bilateral thoracoscopic staple lung volume reduction surgery
Chest
(1997) - et al.
Mechanisms of relief of exertional breathlessness following unilateral bullectomy and lung volume reduction surgery in emphysema
Chest
(1996) - et al.
Comparison of short-term functional outcomes following unilateral and bilateral lung volume reduction surgery
Chest
(1998) - et al.
Short-term and long-term outcomes after bilateral lung volume reduction surgery: prediction by quantitative CT
Chest
(2001) - et al.
Lung function 4 years after lung volume reduction surgery for emphysema
Chest
(1999) - et al.
Correlation of changes in quality of life after lung volume reduction surgery with changes in lung function, exercise, and gas exchange
Chest
(2000) What outcomes should be measured in patients with COPD?
Chest
(2001)
Health-related quality of life improves following pulmonary rehabilitation and lung volume reduction surgery
Chest
Prognostic models of thirty-day mortality and morbidity after major pulmonary resection
Thorac Cardiovasc Surg
Outcome of Medicare patients with chronic emphysema selected for, but denied lung volume reduction operation
Ann Thorac Surg
Improved long-term survival seen after lung volume reduction surgery compared to continued medical therapy for emphysema [letter]
Ann Thorac Surg
National vital statistics report (vol 50, no 16)
Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease
Am J Respir Crit Care Med
Life quality of patients with chronic obstructive pulmonary disease
Arch Intern Med
Surgical treatment of pulmonary emphysema
Am Surg
Lung-volume reduction improves dyspnea, dynamic hyperinflation, and respiratory muscle function
Am J Respir Crit Care Med
A randomized, prospective trial of stapled lung reduction vs laser bullectomy for diffuse emphysema
Thorac Cardiovasc Surg
Improvement in pulmonary function and elastic recoil after lung-reduction surgery for diffuse emphysema
N Engl J Med
Effect of lung volume reduction surgery on diaphragm strength
Am J Respir Crit Care Med
Prospective randomized trial comparing bilateral lung volume reduction surgery to pulmonary rehabilitation in severe chronic obstructive pulmonary disease
Chest
Effect of lung-volume-reduction surgery in patients with severe emphysema
N Engl J Med
Mechanism of short term improvement in lung function after emphysema resection
Am J Respir Crit Care Med
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2020, Surgery (United States)Citation Excerpt :There were only 5 multi-center studies. Studies were heterogeneous with respect to several factors: race, sex, and type of study (randomized versus nonrandomized) (Table I).19ā76 Variation in these factors was broadly reflective of known differences that exist between Asian and Western populations.
Endobronchial coils for the treatment of severe emphysema with hyperinflation (RESET): A randomised controlled trial
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2011, Primary Care - Clinics in Office PracticeCitation Excerpt :Results from the National Emphysema Treatment Trial, a randomized, multicenter trial comparing LVRS with medical treatment, showed improved exercise capacity, quality of life, and reduced mortality in patients with both predominantly upper-lobe emphysema and low baseline exercise capacity.62 Most of the benefit was maintained for at least 2 years and as long as 5 years after LVRS.63 Although LVRS may be helpful for some patients, many patients with end-stage COPD have specific risk factors (low FEV1, homogeneous emphysema, or very low carbon monoxide diffusing capacity) for increased risk of death following surgery.64
Supported, in part, by the National Heart, Lung, and Blood Institute of the National Institutes of Health, grant number 5 K23 HL04236-02 (Dr. Yusen).
Dr. Cooper receives a royalty from Biovascular, Inc., for his development of the Peristrip staple-line reinforcement.
Dr. Yusen is a consultant for Spiration, Inc.