April 29, 2015 — Mark Ginsburg, MD, Associate Professor of Surgery, Division of Cardiac, Vascular, and Thoracic Surgery at Columbia University Medical Center, presented ten-year data on lung volume reduction surgery (LVRS) at the 95th annual meeting of the American Association for Thoracic Surgery (AATS). These noteworthy results, based primarily on surgical experience in the Division of Thoracic Surgery at NYP/Columbia, were highlighted at the conference because they show durable benefits that should promote wider adoption of LVRS in patients with severe emphysema.
Emphysema is a chronic, progressive, obstructive lung disease in which the small sacs of the lung (alveoli) are destroyed, leading to air pockets and severe breathing difficulties. In 2011, 4.7 million Americans were diagnosed with emphysema, and in 2013 more than 8200 patients died from the disease. While emphysema traditionally has been treated with medications, a surgical option, lung volume reduction surgery (LVRS), was introduced in 1993. LVRS removes diseased portions of the lung and allows the expansion of remaining, still-functional lung tissue. In 2003, the National Emphysema Treatment Trial (NETT) demonstrated that LVRS improved survival and lung function in select patients with severe emphysema, especially those with mostly upper-lobe emphysema and low exercise capacity (N Engl J Med 2003;348:2059-2073). Soon after these results were published, the Centers for Medicare and Medicaid Services began providing coverage of LVRS.
“Despite these results, adoption of LVRS in the US for the treatment of severe emphysema has been exceedingly poor. A review of the Society of Thoracic Surgery database identified only 538 LVR surgeries over an eight-year period,” stated Dr. Ginsburg.
In the study Dr. Ginsburg presented in April 2015, most patients underwent bilateral video-assisted thoracoscopic surgery (VATS). Results clearly demonstrated that LVRS can be performed safely using minimally invasive surgical techniques, and with lasting benefits. At one year patients’ lung function improved by a mean of 43%, and at five years after surgery, improvement was 44%, indicating that results of the surgery are durable.
“Surgical LVRS remains the gold standard against which all other forms of lung volume reduction must be judged. Surgical LVRS should be more widely offered to patients with advanced emphysema who meet CMS selection criteria,” concluded Dr. Ginsburg.