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Non-Intubated Video-Assisted Thoracoscopic Surgery
Published on: May 26, 2023
Lung volume reduction surgery using the NETT selection criteria
Mark E Ginsburg1, Byron M Thomashow, Chun K Yip
1Department of Surgery, Columbia University College of Physicians and Surgeons, Medical Center, New York, New York 10032, USA. meg18@columbia.edu
The Annals of Thoracic Surgery
|April 5, 2011
Summary
Lung volume reduction surgery (LVRS) for emphysema is safe and effective in selected patients, showing significant improvements in lung function and survival rates. This surgical approach sets a benchmark for advanced emphysema treatments.
Area of Science:
- Pulmonary Medicine
- Thoracic Surgery
- Respiratory Physiology
Background:
- The National Emphysema Treatment Trial (NETT) established lung volume reduction surgery (LVRS) as safe and effective for specific emphysema patients.
- This study applied NETT selection criteria to 49 patients undergoing bilateral LVRS between February 2004 and May 2009.
Purpose of the Study:
- To evaluate the safety and efficacy of LVRS in emphysema patients selected using NETT criteria.
- To assess midterm clinical outcomes, including survival and lung function, following LVRS.
Main Methods:
- Bilateral LVRS was performed via median sternotomy (10 patients) or video-assisted thoracoscopic surgery (39 patients).
- Patient selection adhered to NETT inclusion-exclusion criteria, focusing on upper lobe predominant disease and varying exercise capacity.
- Preoperative assessments included FEV1, DLCO, and BODE index.
Main Results:
- No operative or 90-day mortality was observed; median length of stay was 8 days.
- Significant improvements were noted in the BODE index (-2.3, p<0.0001) and FEV1 (+286 cc, p<0.0001) one year post-surgery.
- Midterm survival rates were high: 0.98 at 1 year and 0.95 at 3 years.
Conclusions:
- LVRS, using NETT selection criteria, offers a very low surgical risk and excellent midterm outcomes for advanced emphysema.
- Surgical LVRS serves as the gold standard for comparison with emerging nonsurgical treatments for severe emphysema.
