Surgery Aids Emphysema Patients : Medicine: Volume reduction removes 20% of diseased lungs in severe cases. It's not a cure, but it can make some transplant operations unnecessary, proponents say.

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Lynn Marantz suffered so much from emphysema she couldn't even walk and talk at the same time.

"It's a horrible life," she said. "The worst part was that I couldn't laugh."

That was until the 43-year-old Chicago woman underwent an operation called volume reduction that removes from 20% to 30% of the diseased lungs of sufferers of severe emphysema and improves their ability to breathe.

The procedure was developed by Dr. Joel Cooper, professor of cardiothoracic surgery at the Washington University School of Medicine. Cooper, who pioneered lung transplant operations, says volume reduction could make some of those surgeries unnecessary.

"If you've never had the disease, you can't imagine how it feels," said Marantz, who recently was back at Barnes Hospital for a checkup a year after undergoing the operation.

"Now I laugh at the slightest excuse," she said shortly after a brisk walk on a treadmill. "I'm enjoying just being alive. That's not a small thing."

People who undergo the operation have an average improvement in their lung function of 70% to 90%, Cooper said. That's a sharp improvement in the quality of life for the majority of the 20 patients who've had the operation in the last 15 months, he said.

Cooper presented the results of his research recently in New York during the annual meeting of the American Assn. of Thoracic Surgery.

Other doctors say the procedure is so new they have yet to see much data on it. But they like what they have seen.

"The results of (Cooper's) research . . . are surprisingly promising," said Dr. Norman Edelman, consultant for scientific affairs for the American Lung Assn. and a professor at Robert Wood Johnson Medical School in New Brunswick, N.J.

Cooper says many people now on waiting lists for lung transplants have emphysema, a severely debilitating, progressive disease that afflicts an estimated 1.65 million Americans. It's caused primarily by smoking, but there are an estimated 70,000 to 100,000 cases in the United States in which it was caused by an inherited protein deficiency.

Emphysema sufferers have to struggle for every breath and eventually must depend on supplemental oxygen until even that isn't enough to keep them alive.

Like a blown-up balloon, healthy lungs shrink to normal size when air is let out of them. Emphysema robs the air sacs in the lungs of their elasticity, which keeps them from deflating and causes other damage. As time goes on, sufferers must take deeper and deeper breaths to get even a little fresh air into the functioning part of their lungs.

This causes the lungs to grow and enlarges the chest cavity. The ribs are spread apart, and the diaphragm, which is important to normal breathing, becomes flattened into the bottom of the chest cavity.

"I'll tell you how it feels," Marantz said. "Take a deep breath and hold it. Then, when you need to take another breath, don't breathe out, but try to take more air in.

"Terrible, isn't it? That's how I used to have to fight for every breath I took."

Cooper, who performed the first successful single lung transplant in 1983, said his experience in transplants led to the new procedure.

"Volume reduction is not a new concept," he said. "But when it was first proposed 35 years ago by Dr. Otto Brantigan, it was considered a crazy notion."

Brantigan, a surgeon with the University of Maryland and Baltimore City Hospital, performed a number of similar operations with at least some success. But the early mortality rate of 16% overshadowed any gains and the procedure never gained widespread acceptance.

But technology and techniques have changed radically since then, Cooper said, noting that lung transplants once were believed to be impossible too.

"I noticed that immediately after transplant surgery the patient's chest returned to nearly normal size and the diaphragm returned to its normal position," he said. "That made the idea of volume reduction less crazy. Now we know that it's very workable, with the right team and the right techniques."

Volume reduction isn't for everyone, though, Cooper warned.

"To begin with, it's major surgery," he said. "I make the same incision that would be made for open heart surgery so that we can see both lungs. But it can be done safely, and it can be done on people of all ages. Our first 20 patients ranged in age from 39 to 76. All are still living."

So far only two patients have required further surgery to correct minor problems, Cooper said. Hospital stays for the 20 ranged from seven to 48 days, and recent improvements in stapling techniques are making for shorter stays.

Both Cooper and Edelman stress that the final results aren't in on the surgery and that only time will confirm what seems to be a positive step for many patients.

The patients still will have emphysema, and the disease will progress, Cooper said. But the procedure can be used as a "bridge" to buy time for people who eventually need a transplant when a donor becomes available, he said.

It also can be an alternative for many people on the current transplant list, Cooper said. Transplants should be the last resort because of the fear of rejection and the problems the required immunosuppressant drugs can cause, he said.

"The time for a transplant is the day before it's too late," Cooper said.

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