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A Comprehensive Approach to Lung Volume Reduction Encompassing Surgical and Endobronchial Treatment of Severe
Wim Janssens1, S Everaerts1, N Filipow1
1Departments of Respiratory Diseases, UZ Leuven, Belgium, CHROMETA Department, KU Leuven, Belgium.
Background:
Randomized controlled trials with lung volume reduction surgery (LVRS) or endobronchial valves (EBVs) have shown clinically significant benefits for specific patients with emphysema.
Research Question:
What is the impact of a comprehensive lung volume reduction (LVR) program, with both LVRS and EBVs as treatment options, on patient selection and short- and long-term outcomes in real life?
Study Design And Methods:
This study summarizes the results of a prospective comprehensive LVR program in tertiary care, based on 5-year inclusions and follow-up over 1 to 3 years.
Results:
A total of 429 cases were discussed at a multidisciplinary emphysema board; of these, 131 (30%) were referred for LVRS, 73 (17%) were referred for EBV, 25 (6%) were referred for lung transplantation, and 200 (47%) were referred for usual care. A total of 38 (52%) of the EBV interventions were followed by a second to fourth intervention, including LVRS in 25 (34%). For LVRS first, 72 (55%) and 37 (38%) of patients had a single 1-stage bilateral or unilateral LVRS procedure, and 22 (17%) had a staged procedure. Clinically significant improvements between baseline and follow-up visits were obtained on all outcome dimensions in all LVRS and EBV groups for most of the visits. Responder rates varied between 50% and 80% at 3 months to 1 year and slowly declined in the second year. Transplant-free survival over 2.5 years, adjusted for age and BODE Index at baseline, was significantly better for the EBV intervention (hazard ratio, 0.14; 95% CI, 0.04-0.44) and borderline significant for LVRS (hazard ratio, 0.7; 95% CI, 0.45-1.2) compared with the nonintervention group.
Interpretation:
LVR programs should cover both surgical and bronchoscopic interventions to maximize eligibility and to improve outcome and prognosis of highly symptomatic patients with severe emphysema.
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