Lung Volume Reduction Surgery vs Medical Treatment

Objective To contribute to the knowledge on the therapeutic value of lung volume reduction surgery (LVRS) Design Two similar, independently conceived and conducted, multicenter, randomized clinical trials Setting The Canadian Lung Volume Reduction (CLVR) study and the Overholt-Blue Cross Emphysema Surgery Trial (OBEST) Methods Using a fixed-effects meta-analysis, the 6-month results produced by the addition of LVRS to optimal medical therapy were compared to those obtained from optimal medical therapy alone. Patients were required to have severe emphysema, marked airflow limitation ( ie , FEV 1 , 15 to 40% predicted), hyperinflation (total lung capacity [TLC], > 120% predicted), CO 2 , Results The CLVR study randomized 58 patients and the OBEST randomized 35 patients for a total of 93 patients. Of these, 54 patients were randomized to undergo surgery, and 39 patients were randomized to receive medical treatment. The 6-month mortality rate (including operative mortality) in the surgical and medical cohorts was similar (5.6% vs 5.1%, respectively). A comparison of the medical and surgical arms of the combined CLVR study/OBEST population showed that LVRS was associated with a higher FEV 1 (167 mL or 24% predicted; 95% confidence interval [CI], 29 to 304; p = 0.017), lower residual volume (−1,342 mL or 24.5% predicted; 95% CI, −1,844 to −840; p Conclusion Six months after randomization, LVRS produced better palliation than optimal medical therapy in patients with advanced emphysema