Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2011 Nov 10:6:148.
doi: 10.1186/1749-8090-6-148.

Several clinical interests regarding lung volume reduction surgery for severe emphysema: meta-analysis and systematic review of randomized controlled trials

Wei Huang  1 , Wen R Wang, Bo Deng, You Q Tan, Guang Y Jiang, Hai Jing Zhou, Yong He
Affiliations
Meta-Analysis

Several clinical interests regarding lung volume reduction surgery for severe emphysema: meta-analysis and systematic review of randomized controlled trials

Wei Huang et al. J Cardiothorac Surg. .

Abstract

Objectives: We aim to address several clinical interests regarding lung volume reduction surgery (LVRS) for severe emphysema using meta-analysis and systematic review of randomized controlled trials (RCTs).

Methods: Eight RCTs published from 1999 to 2010 were identified and synthesized to compare the efficacy and safety of LVRS vs conservative medical therapy. One RCT was obtained regarding comparison of median sternotomy (MS) and video-assisted thoracoscopic surgery (VATS). And three RCTs were available evaluating clinical efficacy of using bovine pericardium for buttressing, autologous fibrin sealant and BioGlue, respectively.

Results: Odds ratio (95%CI), expressed as the mortality of group A (the group underwent LVRS) versus group B (conservative medical therapies), was 5.16(2.84, 9.35) in 3 months, 3(0.94, 9.57) in 6 months, 1.05(0.82, 1.33) in 12 months, respectively. On the 3rd, 6th and 12th month, all lung function indices of group A were improved more significantly as compared with group B. PaO2 and PaCO2 on the 6th and 12th month showed the same trend. 6MWD of group A on the 6th month and 12th month were improved significantly than of group B, despite no difference on the 3rd month. Quality of life (QOL) of group A was better than of group B in 6 and 12 months. VATS is preferred to MS, due to the earlier recovery and lower cost. And autologous fibrin sealant and BioGlue seems to be the efficacious methods to reduce air leak following LVRS.

Conclusions: LVRS offers the more benefits regarding survival, lung function, gas exchange, exercise capacity and QOL, despite the higher mortality in initial three postoperative months. LVRS, with the optimization of surgical approach and material for reinforcement of the staple lines, should be recommended to patients suffering from severe heterogeneous emphysema.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Meta-analysis of mortality of group A and group B in 3,6 and 12 months. A: mortality in 3 months (including Fishman's study); B: mortality in 6 months; C: mortality in 12 months(including Fishman's study); D mortality in 3 months (excluding Fishman's study); E mortality in 12 months (excluding Fishman's study).
See this image and copyright information in PMC

References

    1. Decramer M. Treatment of chronic respiratory failure: lung volume reduction surgery versus rehabilitation. Eur Respir J Suppl. 2003;47:47s–56s. - PubMed
    1. Hillerdal G, Lofdahl CG, Strom K, Skoogh BE, Jorfeldt L, Nilsson F. et al. Comparison of lung volume reduction surgery and physical training on health status and physiologic outcomes: a randomized controlled clinical trial. Chest. 2005;128(5):3489–99. doi: 10.1378/chest.128.5.3489. - DOI - PubMed
    1. Sardenberg RA, Younes RN, Deheizelin D. Lung volume reduction surgery: an overview. Rev Assoc Med Bras. 2010;56(6):719–23. doi: 10.1590/S0104-42302010000600025. - DOI - PubMed
    1. Rationale and design of the National Emphysema Treatment Trial (NETT): A prospective randomized trial of lung volume reduction surgery. J Thorac Cardiovasc Surg. 1999;118(3):518–28. - PubMed
    1. Celli BR, MacNee W. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004;23(6):932–46. doi: 10.1183/09031936.04.00014304. - DOI - PubMed

Substances