The investigators also found that patients whose disease was concentrated in the upper lobes of the lungs and whose exercise capacity was low before surgery were more likely to survive longer and function better after surgery than those who received medical management alone. In contrast, patients who had more diffuse disease and greater exercise capacity were more likely to develop complications from the surgery.
"The findings provide crucial new information for weighing the benefits and risks of lung volume reduction surgery for the treatment of severe emphysema," said Steven Piantadosi, M.D., Ph.D., professor of oncology at Johns Hopkins and a lead investigator in the study.
Added Robert Wise, M.D., professor of medicine at Johns Hopkins and an author of the report, "They also tell us which patients will respond well to surgery and which ones are at risk of complications."
The researchers noted that although, on average, lung function and exercise capacity among surviving surgical patients improved significantly following LVRS, after two years these indicators returned to the same level as before surgery. In contrast, those who received medical therapy alone experienced losses in lung function to below baseline. Moreover, while the overall mortality rate was similar between the two groups throughout the study period, the risk of death during the first 90 days was significantly higher for patients who underwent surgery compared to those who received medical therapy alone (7.9 percent versus 1.3 percent).