Surgical Procedures

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Comparison in Outcomes Between Surgery and Medical Treatments
	Low Exercise Capacity	High Exercise Capacity
Emphysema in Upper Lungs	Surgical group had better lung function and two-year survival rates than medical group.	Similar mortality rates but surgery group had better lung function.
Emphysema Not in the Upper Lungs	Similar survival rates and similar outcome.	Surgical group had worse survival rates, and both had low chance for improving in lung function.
Data from: A Randomized Trial Comparing Lung-Volume-Reduction Surgery with Medical Therapy for Severe Emphysema. The New England Journal of Medicine. May 22, 2003. No. 21, Vol. 348.

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Poor Candidates for Surgery. Early results from NETT suggest that the following patients have a high risk of a poor prognosis, and are generally not good candidates for LVRS:

Those with a very low FEV1 (less than 20% of expected value), plus
Those with carbon monoxide diffusing capacity of less than 20% of expected value, or
Those with even distribution of emphysema in the lungs

In the study, patients with these characteristics had a 16% mortality rate at 30 days after surgery compared to no deaths in similar patients who were treated with medications only. Such high-risk patients accounted for about 12.5% of the patient population in the study.

Patients may also be excluded if they have severe medical conditions that limit their life span; severe psychological problems; recent tobacco, drug, or alcohol dependence; chest wall deformity; corticosteroid dependence; or scarring around the membrane of the lung. Other indicators for a poor outlook include severe lung complications and isolated bullae (air pockets in diseased area of the lungs).

Specific Techniques. At this time, the preferred technique is bilateral lung volume reduction (surgery is done on both lungs). Surgeons use either an open approach, making a large cut in the chest area, or video-assisted thoracoscopy (VATS), which is less invasive and involves several small cuts. Either method is effective and has similar complication rates. Lines of staples are typically used to reduce lung volume.