Analysis of Clinical Outcomes of Lung Volume Reduction Surgery and Lung Transplantation on End-stage Emphysema_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Ying , CHEN Jingyu , WANG Zhenxing.

Department of Lung Transplantation, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi 214023, Jiangsu, P.R. China;

Corresponding author：

Keywords：

End-stage emphysema; Lung volume reduction surgery; Lung transplantation; Cost-utility

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Abstract: Objective To evaluate the clinical effects and health economics of lung volume reduction surgery（LVRS）, single lung transplantation（SLTx） and bilateral lung transplantation（BLTx） for patients with end-stage emphysema.
Methods A total of 61 patients with end-stage emphysema, including 39 patients who underwent LVRS（LVRS group）, 14 patients who underwent SLTx（SLTx group）, and 8 patients who underwent BLTx（BLTx group） from September 2002 to August 2008 in Wuxi People’s Hospital, were analyzed retrospectively. Lung function, arterial blood gas analysis and 6-minute walk distance（6-MWD）were assessed before their surgery and 6 months, 1-year and 3-year after their surgery respectively. Their 1-year and 3-year survival rates were observed. Cost-effectiveness analyses were made from a health economics perspective. Results Compared with their preoperative results, their mean forced expiratory volume in 1 second（FEV1.0）in LVRS group increased by 75%, 83% and 49% at 6 months, 1-year and 3-year postoperatively, by 176%, 162% and 100% in SLTx group, and by 260%, 280% and 198% in BLTx group respectively. Their mean forced vital capacity（FVC）in LVRS group increased by 21%, 41% and 40% at 6 months, 1-year and 3-year postoperatively, by 68% , 73% and 55% in SLTx group, and by 82%, 79% and 89% in BLTx group respectively. Their exercise endurance as measured by 6-MWD increased by 75%, 136% and 111% in LVRS group at 6 months, 1-year and 3-year postoperatively, by 513%, 677% and 608% in SLTx group, and by 762%, 880% and 741% in BLTx group respectively. The 1-year and 3-year survival rates after operation were 74.40% and 58.90% in LVRS group, 85.80% and 64.30% in SLTxgroup, and 62.50% and 50.00% in BLTx group respectively. The three years’ cost utility of SLTx group was significantly higher than that of BLTx group（1 668.00 vs.1 168.55, P＜ 0.05）and LVRS group （1 668.00 vs. 549.46, P＜ 0.05）. Conclusion SLTx and BLTx are better than LVRS in improving patients’ lung function and exercise endurance for end-stage emphysema patients. LVRS is more cost-effective than SLTx and BLTx in the early postoperative period. With the development of medical technology and decreased expenses of lung transplantation and immunosuppressive agents, lung transplantation will become the first surgical choice for end-stage emphysema patients.

Citation： CHEN Ying,CHEN Jingyu,WANG Zhenxing.. Analysis of Clinical Outcomes of Lung Volume Reduction Surgery and Lung Transplantation on End-stage Emphysema. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(2): 141-144. doi: Copy

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2.	Cordova FC, Criner GJ.Surgery for chronic obstructive pulmonary disease： the place for lung volume reduction and transplantation. Curr Opin Pulm Med, 2001, 7 （2）：93-104.
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11.	Christie JD, Edwards LB, Aurora P, et al. Registry of the International Society for Heart and Lung Transplantation： twenty-fifth official adult lung and heart/lung transplantation report-2008. J Heart Lung Transplant, 2008, 27 （9）：957-969.
12.	Cano JR, Algar FJ, Cerezo F, et al. Results of lung transplantation in patients with chronic obstructive pulmonary disease.Transplant Proc, 2008, 40 （9）：3073-3075.
13.	Orens JB, Estenne M, Arcasoy S, et al. International guidelines for the selection of lung transplant candidates： 2006 update-a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation.J Heart Lung Transplant, 2006, 25 （7）：745-755.
14.	Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease.N Engl J Med, 2004, 350 （10）：1005-1012.
15.	Naunheim KS, Wood DE, Krasna MJ, et al. Predictors of operative mortality and cardiopulmonary morbidity in the National Emphysema Treatment Trial.J Thorac Cardiovasc Surg, 2006, 131 （1）：43-53.
16.	Delgado M, Borro JM, De La Torre MM, et al. Lung transplantation as the first choice in emphysema.Transplant Proc, 2009, 41 （6）：2207-2209.
17.	Gaissert HA, Trulock EP, Cooper JD, et al. Comparison of early functional results after volume reduction or lung transplantation for chronic obstructive pulmonary disease. J Thorac Cardiovasc Surg, 1996, 111 （2）：296-307.
18.	Gilbert S, Zheng B, Leader JK, et al. Computerized estimation of the lung volume removed during lung volume reduction surgery.Acad Radiol, 200613 （11）：1379-1386.
19.	Weder W, Tutic M, Bloch KE. Lung volume reduction surgery in nonheterogeneous emphysema.Thorac Surg Clin, 2009, 19 （2）：193-199.
20.	Bittencourt ZZ, Alves Filho G, Mazzali M, et al. Quality of life in renal transplant patients： impact of a functioning graft. Rev Saude Publica, 2004, 38 （5）：732-734．.

1. 　Criner GJ, Sternberg AL. National Emphysema Treatment Trial： the major outcomes of lung volume reduction surgery in severe emphysema. Proc Am Thorac Soc, 2008, 5 （4）：393-405.
2. 　Cordova FC, Criner GJ.Surgery for chronic obstructive pulmonary disease： the place for lung volume reduction and transplantation. Curr Opin Pulm Med, 2001, 7 （2）：93-104.
3. 　陈静瑜, 郑明峰, 朱艳红, 等.肺移植治疗特发性肺间质纤维化32例报告.中华器官移植杂志, 2010, 31 （4）：213-215.
4. 　陈静瑜.胸部微创技术在肺移植切口中的应用.中国微创外科杂志, 2006, 6（9）：648-649. .
5. 　于坤, 黑飞龙, 李景文, 等.两种体外膜式氧合支持系统的临床应用研究.中国胸心血管外科临床杂志, 2011, 18 （1）：16-21.
6. 　蒲江涛, 刘伦旭.肺移植手术中供肺保存液的研究现状.中国胸心血管外科临床杂志, 2007, 14 （3）：216-220.
7. 　都元涛, 方积乾. 世界卫生组织生存质量测定量表中文版介绍及其使用说明. 现代康复, 2000, 4 （8）：1127-1129.
8. 　Cooper JD, Trulock EP, Triantafillou AN, et al. Bilateral pneumectomy （volume reduction） for chronic obstructive pulmonary disease. J Thorac Cardiovasc Surg, 1995, 109 （1）：106-119.
9. 　Fishman A, Martinez F, Naunheim K, et al. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema.N Engl J Med, 2003, 348 （21）：2059-2073.
10. 　Christie JD, Edwards LB, Kucheryavaya AY, et al. The Registry of the International Society for Heart and Lung Transplantation： twenty-seventh official adult lung and heart-lung transplant report-2010. J Heart Lung Transplant, 2010, 29 （10）：1104-1118.
11. 　Christie JD, Edwards LB, Aurora P, et al. Registry of the International Society for Heart and Lung Transplantation： twenty-fifth official adult lung and heart/lung transplantation report-2008. J Heart Lung Transplant, 2008, 27 （9）：957-969.
12. 　Cano JR, Algar FJ, Cerezo F, et al. Results of lung transplantation in patients with chronic obstructive pulmonary disease.Transplant Proc, 2008, 40 （9）：3073-3075.
13. 　Orens JB, Estenne M, Arcasoy S, et al. International guidelines for the selection of lung transplant candidates： 2006 update-a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation.J Heart Lung Transplant, 2006, 25 （7）：745-755.
14. 　Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease.N Engl J Med, 2004, 350 （10）：1005-1012.
15. 　Naunheim KS, Wood DE, Krasna MJ, et al. Predictors of operative mortality and cardiopulmonary morbidity in the National Emphysema Treatment Trial.J Thorac Cardiovasc Surg, 2006, 131 （1）：43-53.
16. 　Delgado M, Borro JM, De La Torre MM, et al. Lung transplantation as the first choice in emphysema.Transplant Proc, 2009, 41 （6）：2207-2209.
17. 　Gaissert HA, Trulock EP, Cooper JD, et al. Comparison of early functional results after volume reduction or lung transplantation for chronic obstructive pulmonary disease. J Thorac Cardiovasc Surg, 1996, 111 （2）：296-307.
18. 　Gilbert S, Zheng B, Leader JK, et al. Computerized estimation of the lung volume removed during lung volume reduction surgery.Acad Radiol, 200613 （11）：1379-1386.
19. 　Weder W, Tutic M, Bloch KE. Lung volume reduction surgery in nonheterogeneous emphysema.Thorac Surg Clin, 2009, 19 （2）：193-199.
20. 　Bittencourt ZZ, Alves Filho G, Mazzali M, et al. Quality of life in renal transplant patients： impact of a functioning graft. Rev Saude Publica, 2004, 38 （5）：732-734．.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Analysis of Clinical Outcomes of Lung Volume Reduction Surgery and Lung Transplantation on End-stage Emphysema

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