التفاصيل البيبلوغرافية
| العنوان: |
Long-Term Follow-Up of Patients Receiving Lung-Volume-Reduction Surgery Versus Medical Therapy for Severe Emphysema by the National Emphysema Treatment Trial Research Group. |
| المؤلفون: |
Naunheim, Keith S., Wood, Douglas E., Mohsenifar, Zab, Sternberg, Alice L., Criner, Gerard J., DeCamp, Malcolm M., Deschamps, Claude C., Martinez, Fernando J., Sciurba, Frank C., Tonascia, James, Fishman, Alfred P. |
| المصدر: |
Annals of Thoracic Surgery; Aug2006, Vol. 82 Issue 2, 1p |
| مصطلحات موضوعية: |
PULMONARY emphysema, DISEASES, LUNG diseases, OBSTRUCTIVE lung diseases |
| مستخلص: |
Background: The National Emphysema Treatment Trial defined subgroups of patients with severe emphysema in whom lung-volume-reduction surgery (LVRS) improved survival and function at 2 years. Two additional years of follow-up provide valuable information regarding durability. Methods: A total of 1218 patients with severe emphysema were randomized to receive LVRS or medical treatment. We present updated analyses (4.3 versus 2.4 years median follow-up), including 40% more patients with functional measures 2 years after randomization. Results: The intention-to-treat analysis of 1218 randomized patients demonstrates an overall survival advantage for LVRS, with a 5-year risk ratio (RR) for death of 0.86 (p = 0.02). Improvement was more likely in the LVRS than in the medical group for maximal exercise through 3 years and for health-related quality of life (St. George’s Respiratory Questionnaire [SGRQ]) through 4 years. Updated comparisons of survival and functional improvement were consistent with initial results for four clinical subgroups of non-high-risk patients defined by upper-lobe predominance and exercise capacity. After LVRS, the upper-lobe patients with low exercise capacity demonstrated improved survival (5-year RR, 0.67; p = 0.003), exercise throughout 3 years (p < 0.001), and symptoms (SGRQ) through 5 years (p < 0.001 years 1 to 3, p = 0.01 year 5). Upper-lobe-predominant and high-exercise-capacity LVRS patients obtained no survival advantage but were likely to improve exercise capacity (p < 0.01 years 1 to 3) and SGRQ (p < 0.01 years 1 to 4). Conclusions: Effects of LVRS are durable, and it can be recommended for upper-lobe-predominant emphysema patients with low exercise capacity and should be considered for palliation in patients with upper-lobe emphysema and high exercise capacity. [Copyright &y& Elsevier] |
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