BACKGROUND: Observational and randomized studies have demonstrated that lung volume reduction surgery (LVRS) improves symptoms, lung function, and survival in selected patients with emphysema. In spite of an approximately 3.8 million patient prevalence of the disease in the US, only 119 LVRS procedures were performed nationwide under Medicare during 2008. In order to obtain evidence-based estimate on the size of the patient pool potentially suitable for LVRS, we analyzed the database from our clinical practice that is representative of a substantial segment of the general emphysema population. METHODS: Our pulmonary function test laboratory database between 1996 and 2006 was searched for patients with stage III and IV global initiative for chronic obstructive lung disease (GOLD) who also had lung volumes and carbon monoxide diffusing capacity data. Patients without available chest computed tomographic scans (CT) or with primary diagnoses other than emphysema were excluded. The resultant emphysema cohort was screened using clinical inclusion and exclusion criteria adopted from the National Emphysema Treatment Trial. A suitable clinical profile combined with CT scan evidence of 40% or greater involvement of the lungs and predominantly upper lobe distribution of emphysema were regarded as favorable markers for LVRS. RESULTS: Pulmonary function test criteria were met by 959 patients and CT scans were available in 588 patients, but 175 patients were excluded because of primary diagnoses other than emphysema. In the remaining 413 patients, 61 or 15% exhibited favorable clinical profiles and anatomy for LVRS. CONCLUSIONS: In a subset of patients that resembles a substantial segment of the general population with advanced emphysema, up to 15% appeared potential candidates for LVRS. Formation of a task force by relevant medical specialty and patient advocate organizations to address the apparent underutilization of LVRS is recommended.
BACKGROUND: Observational and randomized studies have demonstrated that lung volume reduction surgery (LVRS) improves symptoms, lung function, and survival in selected patients with emphysema. In spite of an approximately 3.8 million patient prevalence of the disease in the US, only 119 LVRS procedures were performed nationwide under Medicare during 2008. In order to obtain evidence-based estimate on the size of the patient pool potentially suitable for LVRS, we analyzed the database from our clinical practice that is representative of a substantial segment of the general emphysema population. METHODS: Our pulmonary function test laboratory database between 1996 and 2006 was searched for patients with stage III and IV global initiative for chronic obstructive lung disease (GOLD) who also had lung volumes and carbon monoxide diffusing capacity data. Patients without available chest computed tomographic scans (CT) or with primary diagnoses other than emphysema were excluded. The resultant emphysema cohort was screened using clinical inclusion and exclusion criteria adopted from the National Emphysema Treatment Trial. A suitable clinical profile combined with CT scan evidence of 40% or greater involvement of the lungs and predominantly upper lobe distribution of emphysema were regarded as favorable markers for LVRS. RESULTS: Pulmonary function test criteria were met by 959 patients and CT scans were available in 588 patients, but 175 patients were excluded because of primary diagnoses other than emphysema. In the remaining 413 patients, 61 or 15% exhibited favorable clinical profiles and anatomy for LVRS. CONCLUSIONS: In a subset of patients that resembles a substantial segment of the general population with advanced emphysema, up to 15% appeared potential candidates for LVRS. Formation of a task force by relevant medical specialty and patient advocate organizations to address the apparent underutilization of LVRS is recommended.
Authors: Carolyn E Come; Mordechai R Kramer; Mark T Dransfield; Muhanned Abu-Hijleh; David Berkowitz; Michela Bezzi; Surya P Bhatt; Michael B Boyd; Enrique Cases; Alexander C Chen; Christopher B Cooper; Javier Flandes; Thomas Gildea; Mark Gotfried; D Kyle Hogarth; Kumaran Kolandaivelu; William Leeds; Timothy Liesching; Nathaniel Marchetti; Charles Marquette; Richard A Mularski; Victor M Pinto-Plata; Michael A Pritchett; Samaan Rafeq; Edmundo R Rubio; Dirk-Jan Slebos; Grigoris Stratakos; Alexander Sy; Larry W Tsai; Momen Wahidi; John Walsh; J Michael Wells; Patrick E Whitten; Roger Yusen; Javier J Zulueta; Gerard J Criner; George R Washko Journal: Eur Respir J Date: 2015-04-02 Impact factor: 16.671
Authors: Carolyn E Come; Alejandro A Diaz; Douglas Curran-Everett; Nivedita Muralidhar; Craig P Hersh; Jordan A Zach; Joyce Schroeder; David A Lynch; Bartolome Celli; George R Washko Journal: Chest Date: 2013-06 Impact factor: 9.410
Authors: Samuel J Clark; Zaid Zoumot; Olivia Bamsey; Michael I Polkey; Michael Dusmet; Eric Lim; Simon Jordan; Nicholas S Hopkinson Journal: Clin Med (Lond) Date: 2014-04 Impact factor: 2.659
Authors: Michael S Binkley; Joseph B Shrager; Aadel Chaudhuri; Rita Popat; Peter G Maxim; David Benjamin Shultz; Maximilian Diehn; Billy W Loo Journal: Radiat Oncol Date: 2016-03-15 Impact factor: 3.481