O.C. Doctor to Participate in Lung Surgery Evaluation

An Orange County specialist will be able to resume performing a controversial lung surgery on Medicare patients as part of federal study of the procedure’s safety and effectiveness.

The announcement Friday by the National Heart, Lung and Blood Institute and the Health Care Financing Administration, which controls Medicare coverage, brought relief to hundreds of desperate emphysema patients counting on the procedure to allow them to breathe more freely.

“If they can do me some good, great,” said Leon Brey, 76, of Arcadia, whose 35-year smoking habit has left him tethered to an oxygen tank 24 hours a day. “They told me once I get through it . . . I should be able to go out and play golf again.”

Brey and scores of other patients around the country were forced to cancel or put off lung operations at two Orange County hospitals last January when the federal government cut off Medicare funding until more testing could be done. Almost all the patients who undergo the surgery are Medicare recipients.

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During the procedure, called lung volume reduction surgery, doctors attempt to improve breathing by removing the most diseased part of the lungs.

Since the technique was perfected about three years ago, critics charge that the complex surgery has spread too quickly to hospitals not equipped to handle it, endangering patient lives and driving up costs.

Officials hope the federal study will determine which patients are the best candidates for the $30,000 procedure, whether the risk of death outweighs the potential benefits and what the long-term effects of the surgery will be--before it is approved for more widespread use.

“The cookbook needs to be written for how to do this successfully,” said Dr. Robert McKenna Jr., director of lung surgery at Chapman Medical Center in Orange.

McKenna said Friday that he may be able to start rescheduling surgeries by midsummer. McKenna, one of 18 “investigators” chosen for the study nationwide, also will perform the procedures at Cedars-Sinai and UCLA medical centers in Los Angeles.

For emphysema sufferers, “the quality of life is horrible,” said McKenna, who has performed more than 400 of the surgeries. “To be able to do something to dramatically improve that is very important.”

The six-year trial will involve about 2,600 carefully screened emphysema patients. Only one in four patients are candidates, largely because most lack the proper pattern of disease that permits removal of affected tissue, McKenna said.

All patients in the study will get aggressive conventional treatment for their lung disease and half will be randomly assigned to undergo surgery.

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McKenna said the length of the trial is necessary to ensure there are enough patients in each group and to provide follow-up time to test the rate of survival.

The study does not include another controversial lung reduction procedure pioneered by Dr. Akio Wakabayashi of Irvine Medical Center involving the use of a laser to remove diseased tissue and a surgical stapler.

Wakabayashi, who has done far more of the procedures than anyone else in the country, was forced to postpone 38 surgeries when Medicare discontinued funding.

Dr. Gail Weinmann, who is helping to oversee the study for the National Heart, Lung and Blood Institute, said the laser technique was not included in the study because “based on the data we have so far, the excision method seemed to be more effective than the laser.”

But Ann Warde, an Irvine Medical Center spokeswoman, said the hospital intends to push for the study to include Wakabayashi.

“We’re still hopeful that they will allow him to pursue the technique that he does and evaluate the process he does,” she said.

For Diantha Czech of Amery, Wis., news of the federal study brought cautious hope.

Last December, Czech, 65, had her bags packed, plane tickets in hand, ready to fly to Orange County for the surgery. Two days before her surgery, McKenna’s office called to cancel, said Czech, who has had emphysema for 10 years.

Now, she said, she’s afraid to count on it, afraid she just might end up in the control group.

“I’m really happy about it, but I’m taking a wait-and-see attitude.”