PMID- 15987235
OWN - NLM
STAT- MEDLINE
DCOM- 20051006
LR  - 20191109
IS  - 1176-3450 (Print)
IS  - 1176-3450 (Linking)
VI  - 4
IP  - 3
DP  - 2005
TI  - Lung volume reduction surgery: a meta-analysis of randomized clinical trials.
PG  - 201-9
AB  - BACKGROUND: Observational studies have suggested that lung volume reduction 
      surgery (LVRS) is superior to optimal medical therapy for selected subsets of 
      patients with advanced emphysema. Randomized clinical trials (RCTs) with the 
      exception of the National Emphysema Treatment Trial (NETT), failed to enroll a 
      sufficient number of patients to provide clinicians and patients with convincing 
      outcome data on the usefulness of LVRS. It was postulated that a meta-analysis of 
      these RCTs (3-12 months' follow up) may provide more compelling information on 
      the value of LVRS in patients with emphysema. METHODS: A comprehensive search of 
      the MEDLINE database between January 1994 and January 2004 for RCTs on LVRS was 
      performed. RESULTS: From a total of eight RCTs on record, six studies (306 
      patients) with 3- to 12-month follow up were deemed suitable for meta-analysis. 
      Key baseline features of these RCT populations included heterogeneous emphysema, 
      comparable inclusion/exclusion criteria and, in retrospect, low walking capacity 
      as measured by the 6-minute walk distance (6MWD). This profile closely resembles 
      NETT's 'predominantly upper lobe--low exercise tolerance emphysema' cohort. The 
      LVRS arm of the meta-analysis population showed better results than the medical 
      cohort in terms of pulmonary function (FEV(1) p < 0.0001, FVC p < 0.0001, 
      residual volume p < 0.0001, total lung capacity p = 0.004), gas exchange 
      (arterial partial pressure of oxygen p < 0.0001) and exercise capacity (6MWD p = 
      0.0002). Although information on quality-of-life measures was not sufficiently 
      uniform to qualify for meta-analysis, a survey of available data revealed better 
      results in the surgical than in the medical arms of each RCT. Mortality 6-12 
      months after random assignment to treatment was similar in the two study arms, 
      suggesting that the operative mortality from LVRS was offset, within months, by 
      deaths in the medical arm. CONCLUSIONS: This meta-analysis showed that a selected 
      subset of patients with advanced, heterogeneous emphysema and low exercise 
      tolerance (6MWD) experienced better outcomes from LVRS than from medical therapy.
FAU - Berger, Robert L
AU  - Berger RL
AD  - Department of Surgery, Harvard Medical School, Boston, Massachusetts 02445, USA. 
      robert_berger@hms.harvard.edu
FAU - Wood, Kathryn A
AU  - Wood KA
FAU - Cabral, Howard J
AU  - Cabral HJ
FAU - Goodnight-White, Sheila
AU  - Goodnight-White S
FAU - Ingenito, Edward P
AU  - Ingenito EP
FAU - Gray, Anthony
AU  - Gray A
FAU - Miller, John
AU  - Miller J
FAU - Springmeyer, Steven C
AU  - Springmeyer SC
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Treat Respir Med
JT  - Treatments in respiratory medicine
JID - 101196148
SB  - IM
MH  - Aged
MH  - Emphysema/physiopathology/*surgery
MH  - Follow-Up Studies
MH  - Forced Expiratory Volume/physiology
MH  - Humans
MH  - *Pneumonectomy/methods/mortality
MH  - Pulmonary Gas Exchange/physiology
MH  - Randomized Controlled Trials as Topic
MH  - Retrospective Studies
MH  - Survival Rate
MH  - Treatment Outcome
EDAT- 2005/07/01 09:00
MHDA- 2005/10/07 09:00
CRDT- 2005/07/01 09:00
PHST- 2005/07/01 09:00 [pubmed]
PHST- 2005/10/07 09:00 [medline]
PHST- 2005/07/01 09:00 [entrez]
AID - 434 [pii]
AID - 10.2165/00151829-200504030-00004 [doi]
PST - ppublish
SO  - Treat Respir Med. 2005;4(3):201-9. doi: 10.2165/00151829-200504030-00004.