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J Thorac Cardiovasc Surg 2003;125:457-459
© 2003 The American Association for Thoracic Surgery

Editorials

Lung volume reduction surgery: Tempest in a teapot

From the Department of General Thoracic Surgery, University of Washington, Seattle, Wash.

Received for publication Jan 21, 2003. Accepted for publication Jan 29, 2003. Address for reprints: Douglas E. Wood, MD, University of Washington, Box 356310, 1959 NE Pacific, AA-115, Seattle, WA 98195-6310 (E-mail: dewood@u.washington.edu).

The first 300 words of the full text of this article appear below.

See related article on page 513.

Lung volume reduction surgery (LVRS) has resulted in perhaps the most dynamic controversy within cardiothoracic surgery in recent years. Initial publications reported compelling improvements in pulmonary function and resulted in rapid dissemination of the procedure throughout the United States and the world. The rationale for the enthusiasm was legitimate given the lack of alternative therapies for patients with severe end-stage emphysema. No medical therapy was able to improve pulmonary function or reverse the inexorable decline of breathless patients with emphysema. Only a very small subset of these patients were candidates for the surgical interventions of bullectomy or lung transplantation. Therefore, the opportunity to improve function and quality of life with a new surgical procedure inspired the hopes of desperate patients and their physicians. LVRS was easily the most exciting and innovative addition to general thoracic surgery since the first successful lung transplant procedure 20 years ago.

Parallel to the rapid clinical dissemination of LVRS, controversy emerged regarding the procedure's efficacy, long-term outcomes, selection criteria, and costs. Many clinicians raised legitimate questions regarding the validity of the early clinical reports, citing small patient numbers, incomplete follow-up, selection bias, and survivorship or follow-up bias as multiple factors confounding the interpretation of clinical outcomes from LVRS. Critics pointed at early publications that documented a high surgical mortality, prolonged mechanical ventilation, and prolonged hospital stays in some patients. ¹ Medicare claims data revealed a 1-year mortality after LVRS of 23%, with uncertainty of whether this denoted the expected mortality of a progressive natural history of emphysema, or whether poor results were under-represented because of centers that performed LVRS but did not publish their outcomes. ² These criticisms reflected the normal debate and evolution that are a natural order of dynamic and evolving medical care. Until LVRS, new procedures and . . . [Full Text of this Article]

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Long-term outcome of bilateral lung volume reduction in 250 consecutive patients with emphysema

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J. Thorac. Cardiovasc. Surg. 2003 125: 513-525. [Abstract] [Full Text] [PDF]