Original articleGeneral thoracicAn Evidence-Based Estimate on the Size of the Potential Patient Pool for Lung Volume Reduction Surgery
Section snippets
Materials and Methods
The protocol for this study was approved by the BIDMC Institutional Review Board. The data analyzed were obtained from the PFT laboratory, Online Medical Record, and the Picture Archiving and Communications System (Centricity 2.1, General Electric, Milwaukee, WI) databases.
Results
From the 11-year period under review, 959 patients met GOLD stage III and IV spirometric criteria and had available lung volume as well as diffusion capacity data. From this initial cohort 371 patients were excluded from the study because of lack of stored CT scans, leaving 588 patients with digitally archived chest CT scans. Of these, 175 carried primary diagnoses other than emphysema and were not further studied. The remaining 413 patients with a primary diagnosis of emphysema were screened
Comment
Lung volume reduction surgery underwent one of the most rigorous evaluations of an operative procedure in the history of surgery. The process produced robust evidence that the operation improves symptoms, respiratory physiology, and survival in a clearly identifiable subgroup of patients with advanced emphysema. Data from NETT also suggest that the incidence of COPD exacerbations was reduced after LVRS [18]. Moreover, it has been reported that patients in need of surgery for lung cancer,
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Cited by (23)
Invited Commentary
2020, Annals of Thoracic SurgeryEligibility for Lung Volume Reduction Surgery in Patients With COPD Identified in a UK Primary Care Setting
2020, ChestCitation Excerpt :A CT scan of the thorax is needed to establish that there is an appropriate pattern of emphysema and to exclude features that mean LVRS is less likely to be appropriate, in particular lung fibrosis or extensive bronchiectasis. Data from a US study suggest roughly 15% of patients with an FEV1 < 50% predicted will have favorable CT scan appearances for LVRS.17 A further contributor to low rates of LVRS may be a lack of understanding among physicians regarding the indications for LVRS, perceived difficulties in the referral pathway, and overestimation of associated morbidity and mortality post-LVRS,5 despite LVRS in modern practice having a low mortality.
Lung volume reduction for severe emphysema: good things come in small packages
2019, The Lancet Respiratory MedicineMeeting the challenge of COPD care delivery in the USA: A multiprovider perspective
2016, The Lancet Respiratory MedicineCitation Excerpt :In specific groups of patients, especially those with upper lobe predominance emphysema and low baseline functional capacity, lung volume reduction surgery can improve survival and morbidity.218 Data suggest that about 10–15% of patients with GOLD stage 3–4 (ie, severe) COPD might be eligible for this procedure, and the number of potential candidates is estimated to range from a few thousand to greater than 1 million.219 However, patient access is restricted by the relatively small number of Medicare-designated centres of excellence for the surgery, insufficient physician awareness of potential benefits and candidate selection, and perceptions regarding risk of the procedure.220
Multidetector Computed Tomographic Imaging in Chronic Obstructive Pulmonary Disease. Emphysema and Airways Assessment.
2014, Radiologic Clinics of North AmericaCitation Excerpt :This grading has shown statistically significant correlation between visual scores and panel of standards.51 Since its introduction, subjective grading of emphysema has been used for assessment of severity of emphysema as well as assessment for potential surgical/endobronchial emphysema treatment.52 A validation study comparing objective and subjective quantification was performed, in which the objective quantification of horizontal paper-mounted lung sections by a computer-assisted method of densitometric evaluation of mean lung attenuation was used as a standard of reference, and subjective visual assessments were performed by 3 readers.50