Effect and duration of lung volume reduction surgery

Mid-term results of the Brompton trial

E. Lim, A. Ali, N. Cartwright, I. Sousa, A. Chetwynd, M. Polkey, D. Geddes, J. Pepper, P. Diggle, Peter Goldstraw

Research output: Contribution to journalArticle

Abstract

Although many studies have reported improvement in lung function following LVRS, the magnitude of improvement and subsequent decline has not been evaluated against medical therapy after the second year. Methods: Existing pulmonary function records were collated for each participant since randomisation from the Brompton LVRS trial cohort. Longitudinal data analysis was used to profile the history of medically treated patients and the effect of LVRS. Results: Pulmonary function results were collated from survivors over a median of 25 (17 to 39) months. The estimated immediate increase in mean FEV1 following surgery was +0.2591 (0.179, 0.339), with a rate of change of -0.0051 (-0.009, -0.001) per month compared to medical therapy (p <0.001). The changes in the secondary outcome measures (LVRS compared to medical therapy) were an increase in FVC (p = 0.004), decrease in RV (p <0.001) and TLC (p <0.001), with differences that were maintained over time. The initial reduction in RV/TLC ratio was sustained (p <0.001), but the estimated initial increase in peak flow was accompanied by a gradual decline that was not statistically significant (p = 0.062). KCOc showed no immediate change, but there was a gradual sustained increase with time (p = 0.009). Mean oxygen saturations improved and continued to do so compared to patients on medical therapy (p = 0.001). Conclusion: The immediate increase in FEV1 is not sustained, although the mechanical improvements of LVRS on increasing FVC, reducing both the RV and RV/TLC ratio, appear to be maintained. The important benefits of LVRS may be the gradual and sustained increase in transfer factor accompanied by improved oxygen saturations.

Original languageEnglish (US)
Pages (from-to)188-192
Number of pages5
JournalThoracic and Cardiovascular Surgeon
Volume54
Issue number3
DOIs
StatePublished - Apr 2006
Externally publishedYes

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Pneumonectomy
Lung
Oxygen
Transfer Factor
Therapeutics
Random Allocation
Survivors
History
Outcome Assessment (Health Care)

Keywords

  • Emphysema
  • Lung volume reduction surgery
  • Pulmonary function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Lim, E., Ali, A., Cartwright, N., Sousa, I., Chetwynd, A., Polkey, M., ... Goldstraw, P. (2006). Effect and duration of lung volume reduction surgery: Mid-term results of the Brompton trial. Thoracic and Cardiovascular Surgeon, 54(3), 188-192. https://doi.org/10.1055/s-2005-872953

Effect and duration of lung volume reduction surgery : Mid-term results of the Brompton trial. / Lim, E.; Ali, A.; Cartwright, N.; Sousa, I.; Chetwynd, A.; Polkey, M.; Geddes, D.; Pepper, J.; Diggle, P.; Goldstraw, Peter.

In: Thoracic and Cardiovascular Surgeon, Vol. 54, No. 3, 04.2006, p. 188-192.

Research output: Contribution to journalArticle

Lim, E, Ali, A, Cartwright, N, Sousa, I, Chetwynd, A, Polkey, M, Geddes, D, Pepper, J, Diggle, P & Goldstraw, P 2006, 'Effect and duration of lung volume reduction surgery: Mid-term results of the Brompton trial', Thoracic and Cardiovascular Surgeon, vol. 54, no. 3, pp. 188-192. https://doi.org/10.1055/s-2005-872953
Lim, E. ; Ali, A. ; Cartwright, N. ; Sousa, I. ; Chetwynd, A. ; Polkey, M. ; Geddes, D. ; Pepper, J. ; Diggle, P. ; Goldstraw, Peter. / Effect and duration of lung volume reduction surgery : Mid-term results of the Brompton trial. In: Thoracic and Cardiovascular Surgeon. 2006 ; Vol. 54, No. 3. pp. 188-192.
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abstract = "Although many studies have reported improvement in lung function following LVRS, the magnitude of improvement and subsequent decline has not been evaluated against medical therapy after the second year. Methods: Existing pulmonary function records were collated for each participant since randomisation from the Brompton LVRS trial cohort. Longitudinal data analysis was used to profile the history of medically treated patients and the effect of LVRS. Results: Pulmonary function results were collated from survivors over a median of 25 (17 to 39) months. The estimated immediate increase in mean FEV1 following surgery was +0.2591 (0.179, 0.339), with a rate of change of -0.0051 (-0.009, -0.001) per month compared to medical therapy (p <0.001). The changes in the secondary outcome measures (LVRS compared to medical therapy) were an increase in FVC (p = 0.004), decrease in RV (p <0.001) and TLC (p <0.001), with differences that were maintained over time. The initial reduction in RV/TLC ratio was sustained (p <0.001), but the estimated initial increase in peak flow was accompanied by a gradual decline that was not statistically significant (p = 0.062). KCOc showed no immediate change, but there was a gradual sustained increase with time (p = 0.009). Mean oxygen saturations improved and continued to do so compared to patients on medical therapy (p = 0.001). Conclusion: The immediate increase in FEV1 is not sustained, although the mechanical improvements of LVRS on increasing FVC, reducing both the RV and RV/TLC ratio, appear to be maintained. The important benefits of LVRS may be the gradual and sustained increase in transfer factor accompanied by improved oxygen saturations.",
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AU - Polkey, M.

AU - Geddes, D.

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