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 Rabies viruses reveal wiring in transparent brains
19.01.2017 | Rheinische Friedrich-Wilhelms-Universität Bonn

nachricht On track to heal leukaemia
18.01.2017 | Universitätsspital Bern

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: Traffic jam in empty space

New success for Konstanz physicists in studying the quantum vacuum

An important step towards a completely new experimental access to quantum physics has been made at University of Konstanz. The team of scientists headed by...

Im Focus: How gut bacteria can make us ill

HZI researchers decipher infection mechanisms of Yersinia and immune responses of the host

Yersiniae cause severe intestinal infections. Studies using Yersinia pseudotuberculosis as a model organism aim to elucidate the infection mechanisms of these...

Im Focus: Interfacial Superconductivity: Magnetic and superconducting order revealed simultaneously

Researchers from the University of Hamburg in Germany, in collaboration with colleagues from the University of Aarhus in Denmark, have synthesized a new superconducting material by growing a few layers of an antiferromagnetic transition-metal chalcogenide on a bismuth-based topological insulator, both being non-superconducting materials.

While superconductivity and magnetism are generally believed to be mutually exclusive, surprisingly, in this new material, superconducting correlations...

Im Focus: Studying fundamental particles in materials

Laser-driving of semimetals allows creating novel quasiparticle states within condensed matter systems and switching between different states on ultrafast time scales

Studying properties of fundamental particles in condensed matter systems is a promising approach to quantum field theory. Quasiparticles offer the opportunity...

Im Focus: Designing Architecture with Solar Building Envelopes

Among the general public, solar thermal energy is currently associated with dark blue, rectangular collectors on building roofs. Technologies are needed for aesthetically high quality architecture which offer the architect more room for manoeuvre when it comes to low- and plus-energy buildings. With the “ArKol” project, researchers at Fraunhofer ISE together with partners are currently developing two façade collectors for solar thermal energy generation, which permit a high degree of design flexibility: a strip collector for opaque façade sections and a solar thermal blind for transparent sections. The current state of the two developments will be presented at the BAU 2017 trade fair.

As part of the “ArKol – development of architecturally highly integrated façade collectors with heat pipes” project, Fraunhofer ISE together with its partners...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Sustainable Water use in Agriculture in Eastern Europe and Central Asia

19.01.2017 | Event News

12V, 48V, high-voltage – trends in E/E automotive architecture

10.01.2017 | Event News

2nd Conference on Non-Textual Information on 10 and 11 May 2017 in Hannover

09.01.2017 | Event News

 
Latest News

New Study Will Help Find the Best Locations for Thermal Power Stations in Iceland

19.01.2017 | Earth Sciences

Not of Divided Mind

19.01.2017 | Life Sciences

Molecule flash mob

19.01.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>