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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
PubMed
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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.

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  • 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.