Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Lung surgery benefits emphysema patients for several years

25.03.2003


A procedure known as lung-volume reduction surgery (LVRS) appears to improve overall health and quality of life for individuals with end-stage emphysema, and these effects last as long as five years in more than half of this population, according to researchers at Washington University School of Medicine in St. Louis.



The findings appear in the March issue of the Journal of Thoracic and Cardiovascular Surgery. The procedure was developed at the School of Medicine in 1993 by the study’s principal investigator, Joel D. Cooper, M.D., the Evarts A. Graham Professor of Surgery and head of the Division of Cardiothoracic Surgery.

"Evidence of the success of this surgery in patients with severe emphysema is overwhelming, and these latest findings confirm and underscore its potential for treating this critically ill population," Cooper says. "This publication represents a major, interdisciplinary team effort, which depended on expertise from a variety of areas, including pulmonary medicine, anesthesiology and nurse coordination."


Emphysema is characterized by destruction and overinflation of the lungs. As the lungs become progressively bloated, they fill the chest cavity and thorax, making it difficult to expand and contract during normal breathing. The disease relentlessly progresses and is responsible for close to 17,000 deaths each year in the United States, according to the National Center for Health Statistics.

In select patients, LVRS provides an alternative to lung transplantation, which until recently was the only option for patients with end-stage lung disease that cannot be controlled with drugs. By removing the most diseased portions of the lung, the procedure provides the lungs with more room to expand within the chest cavity.

Though LVRS is not a cure for emphysema, studies suggest that the surgery increases breathing capacity by more than 50 percent. Such improvements allow otherwise debilitated individuals to resume many normal, daily activities, including moderate exercise. This current study is the first to examine the long-term endurance of patients following surgery.

The research team maintained a detailed database of lung function and quality-of-life assessments for the first 250 patients who underwent LVRS at Washington University’s clinical affiliate, Barnes-Jewish Hospital, between January 1993 and June 2000. Follow-up evaluations were performed six months and one year after surgery and again each year afterward. Patients were followed for an average of 4.8 years.

All participants first were enrolled in a rehabilitation program for about three months prior to surgery and were given medical and dietary programs to make sure they were as healthy as possible for the operation. They also remained on fitness and medical regimens after surgery.

At the conclusion of the study, more than 60 percent of the 250 patients were still alive, and only 18 patients had received a lung transplant since undergoing LVRS. Without surgery, it is estimated that half of the 250 patients would have died within three years and that those still alive after five years would have significantly deteriorated.

Overall, the surviving LVRS patients still had measurable improvements in lung function after five years. For example, patients were tested to see how much air they could blow out in one second, a measurement known as forced expiratory volume. Six months after surgery, 95 percent of patients had improved on this test by an average of 54 percent. After five years, 53 percent of patients still had better scores than before surgery, though they were only 7 percent better.

The team also measured the amount of air left in the lungs after a deep exhale, a value called residual volume. People with healthy lungs have low residual-volume scores because very little air remains in the chest cavity after breathing out. Evaluations six months and one year after surgery revealed that 90 percent of participants had improved residual-volume scores, and that residual-volume values declined an average of 30 percent. After five years, 79 percent still had better residual-volume scores than before surgery, and the average improvement was 14 percent better than pre-surgery scores.

Quality-of-life assessments also were positive: Almost 80 percent of patients still reported better quality-of-life scores five years after surgery than before surgery.

"This procedure is not a cure for emphysema," Cooper emphasizes. "No matter how successful the operation, emphysema continues to degrade the lungs and progressively impairs breathing. However, our results confirm that LVRS can in fact extend patients’ lives and allow them to continue participating in normal activities of daily living."

Determining selection criteria is one of the most controversial issues in measuring the effectiveness of LVRS. Cooper’s team therefore analyzed data from patients with potential risk factors. They found that individuals who required surgery to the lower portion of the lungs benefited from the procedure, but their lung function degraded faster than in individuals with damage to the upper portion of the lungs. Other identified risk factors include advanced age, male gender and very low forced expiratory volume.

"We strongly believe that patient selection is one of the keys to success for this procedure," Cooper says. "With rigorous preoperative preparation and stringent participation criteria, lung-volume reduction surgery appears to improve life expectancy and quality of life for patients who otherwise have very poor prognoses."

Gila Z. Reckess | EurekAlert!
Further information:
http://medinfo.wustl.edu/

More articles from Health and Medicine:

nachricht Scientists track ovarian cancers to site of origin: Fallopian tubes
23.10.2017 | Johns Hopkins Medicine

nachricht Researchers release the brakes on the immune system
18.10.2017 | Rheinische Friedrich-Wilhelms-Universität Bonn

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Neutron star merger directly observed for the first time

University of Maryland researchers contribute to historic detection of gravitational waves and light created by event

On August 17, 2017, at 12:41:04 UTC, scientists made the first direct observation of a merger between two neutron stars--the dense, collapsed cores that remain...

Im Focus: Breaking: the first light from two neutron stars merging

Seven new papers describe the first-ever detection of light from a gravitational wave source. The event, caused by two neutron stars colliding and merging together, was dubbed GW170817 because it sent ripples through space-time that reached Earth on 2017 August 17. Around the world, hundreds of excited astronomers mobilized quickly and were able to observe the event using numerous telescopes, providing a wealth of new data.

Previous detections of gravitational waves have all involved the merger of two black holes, a feat that won the 2017 Nobel Prize in Physics earlier this month....

Im Focus: Smart sensors for efficient processes

Material defects in end products can quickly result in failures in many areas of industry, and have a massive impact on the safe use of their products. This is why, in the field of quality assurance, intelligent, nondestructive sensor systems play a key role. They allow testing components and parts in a rapid and cost-efficient manner without destroying the actual product or changing its surface. Experts from the Fraunhofer IZFP in Saarbrücken will be presenting two exhibits at the Blechexpo in Stuttgart from 7–10 November 2017 that allow fast, reliable, and automated characterization of materials and detection of defects (Hall 5, Booth 5306).

When quality testing uses time-consuming destructive test methods, it can result in enormous costs due to damaging or destroying the products. And given that...

Im Focus: Cold molecules on collision course

Using a new cooling technique MPQ scientists succeed at observing collisions in a dense beam of cold and slow dipolar molecules.

How do chemical reactions proceed at extremely low temperatures? The answer requires the investigation of molecular samples that are cold, dense, and slow at...

Im Focus: Shrinking the proton again!

Scientists from the Max Planck Institute of Quantum Optics, using high precision laser spectroscopy of atomic hydrogen, confirm the surprisingly small value of the proton radius determined from muonic hydrogen.

It was one of the breakthroughs of the year 2010: Laser spectroscopy of muonic hydrogen resulted in a value for the proton charge radius that was significantly...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

3rd Symposium on Driving Simulation

23.10.2017 | Event News

ASEAN Member States discuss the future role of renewable energy

17.10.2017 | Event News

World Health Summit 2017: International experts set the course for the future of Global Health

10.10.2017 | Event News

 
Latest News

Taming 'wild' electrons in graphene

23.10.2017 | Physics and Astronomy

Mountain glaciers shrinking across the West

23.10.2017 | Earth Sciences

Scientists track ovarian cancers to site of origin: Fallopian tubes

23.10.2017 | Health and Medicine

VideoLinks
B2B-VideoLinks
More VideoLinks >>>