In many cases of advanced emphysema — a chronic, progressive lung condition that interferes with breathing — reducing the size of the lungs by surgically removing lobes from both sides has been shown to improve both survival and quality of life. But some emphysema patients can’t tolerate this bilateral operation.
Now a study conducted by researchers at the School of Medicine and the University of Pennsylvania Health System has shown that unilateral, or one-sided, lung-volume reduction surgery has significant benefits for some emphysema patients, offering help to those who are not candidates for the bilateral surgery.
The researchers described their work at the recent 42nd annual meeting of the Society of Thoracic Surgeons.
“A certain subset of emphysema patients are poor candidates for bilateral surgery,” said Bryan Meyers, M.D., associate professor of surgery. “Patients who have scarring on one side of their chest from past surgery, patients with coexisting heart conditions and the small segment of patients whose emphysema affects only one side of their lungs — these are all candidates for a unilateral lung-volume reduction procedure.”
The presentation discussed outcomes for 49 emphysema patients who underwent unilateral lung volume reduction surgery at the School of Medicine and Barnes-Jewish Hospital.
After the procedure, the patients on average had more than 30 percent increased lung function as measured by how much air they could blow out with a vigorous breath in one second. Although the improvement in function gradually decreased, as expected with this incurable and progressive disease, the benefits lasted at least three years for the average patient.
Tests also showed that the unilateral surgery patients had lower amounts of air left in the lung after exhalation, indicating they could exhale more thoroughly. This improvement also gradually decreased but lasted at least five years for the average patient.
In addition, requirements for supplemental oxygen declined substantially after the operation.
“We saw not only a functional benefit but also a survival benefit from the unilateral surgery,” Meyers said. “After three years, 83 percent of the patients who had the unilateral procedure were still alive, and after five years, 55 percent had survived. That’s a significant increase in survival rate compared to emphysema patients who don’t have surgery.”
Survival for patients who had the unilateral procedure was the same as for a similar group of patients who had the bilateral procedure, and a national trial of lung-volume reduction surgery clearly demonstrated that the bilateral procedure increases survival.
The current bilateral lung volume reduction procedure was pioneered at the School of Medicine in 1993 to treat end-stage emphysema. Removal of 20 percent to 30 percent of the lung on each side allows the remaining, less-diseased portion of the lung to function better, giving patients an improved quality of life.
“The lungs of emphysema patients are maximally expanded because the lung’s air sacs have lost their elasticity and can’t push air out,” Meyers said. “With the expansion of the lungs and chest, the patients don’t have much ability to move air back and forth.
“But we found if we remove part of the lungs, we make it possible for the ribs and diaphragm to return to a more normal position, and it becomes easier for the patients to breathe.”