Study: Surgery for Emphysema May Be Deadly
A controversial surgical treatment for emphysema results in a high death rate for some patients, according to early results from a nationwide study of treatments for the illness.
The study tracked 1,033 patients who were divided into two groups: one receiving the surgery and the other receiving nonsurgical treatments. Of those patients, 140 fell into the high-risk group--those who already have severe lung damage from the disease.
Among high-risk patients who received the surgery, 16% died within 30 days, an “unacceptable” mortality rate, the study’s authors reported. None of the high-risk patients who did not receive surgery died. For those in the high-risk group who had surgery and survived, the benefits were very small, the study’s authors reported.
The high-risk patients in the study are those who are so ravaged by emphysema that they have very little lung function remaining.
The research, conducted at 17 medical centers nationwide, was reported Tuesday on the Web site of the New England Journal of Medicine in advance of October publication of an article reporting the findings. The journal released the study early because of its importance for the health of patients facing surgery.
The aim of the clinical trial was to identify which patients might benefit from the procedure, known as lung-volume reduction surgery, and who might suffer from it.
The aim of the seemingly paradoxical lung-reduction surgery is to remove damaged lung tissue. For most people with emphysema, damage to the lungs is localized. When that area is surgically removed, breathing can improve dramatically.
The American Lung Assn. reports that nearly 2 million Americans suffer from emphysema, and that smoking cigarettes causes up to 90% of these cases. Each year, the disease kills more than 16,000 people in the U.S. and costs nearly $2.5 billion in health care.
According to Dr. Robert McKenna of Cedars-Sinai Medical Center in Los Angeles, a surgeon and one of the principal investigators for the study, only about 20,000 emphysema patients probably are good candidates for the surgery each year.
“Emphysema is a horribly debilitating disease,” McKenna said. People with the disease “get short of breath in the shower, short of breath getting dressed.”
The disease attacks tiny air sacs in the lungs called alveoli that normally act like little balloons, inflating and deflating with each breath. The delicate tissue of these sacs allows oxygen to move from the air into the bloodstream and carbon dioxide to flow the opposite way. Harmful chemicals in cigarettes cause this lung tissue to disintegrate, resulting in irreversible damage. The sacs become enlarged and lose their elasticity, making breathing difficult.
Doctors who perform the surgery estimate the average improvement is about 70%. But for high-risk patients, the procedure does more harm than good, the study found.
Although McKenna still believes in the procedure, “there are undoubtedly some people that should not have the operation,” he said.
The most important step to slow the progress of the disease is to stop smoking. Beyond that, however, medical treatments that existed before the lung-reduction surgery offer only small benefits.
“The choices of interventions we had to offer were really quite limited,” said Gail Weinmann of the National Heart, Lung and Blood Institute.
Because of those limitations, doctors and patients were buoyed by news of successful lung-reduction surgeries in the mid-1990s. However, some hospitals have experienced high death rates with the surgery. McKenna speculates that in some hospitals, the surgery may have been performed by surgeons lacking enough technical expertise or that doctors used poor judgment in selecting patients.
