Experts Find Dangers in Emphysema Surgery
Aug. 15, 2001 -- After taking another look at an operation that has been becoming more common for emphysema patients, researchers have found the procedure can be dangerous and even deadly to some people with severe cases of the disease.
Emphysema is a disease largely associated with smoking and strikes about 2 million Americans each year. In recent years, doctors have been studying the effects of removing portions of the lung tissue to treat some of these patients.
When the National Institutes of Health began to follow up on what was happening to people who had this surgery, however, the investigators found 16% of those who had severe forms of the disease were dead within a month of the operation. Those who survived showed limited benefit from the procedure.
Researchers immediately halted more surgery on patients with the same characteristics of advanced illness. They are now confining their testing to more than 1,000 other emphysema patients because the surgery may still help them.
The investigators will publish the findings Oct. 11 in The New England Journal of Medicine but released them Tuesday to alert doctors and patients immediately.
Over the past few years, doctors had shown a lot of optimism with this surgery. In 1999, for example, the American College of Chest physicians assembled in Chicago and learned the procedure looked promising. Researchers had followed nearly 200 patients who received the surgery in St. Louis to treat their severe emphysema. The team found that 94% survived and 71% were still alive five years later.
The doctors had asked the patients to fill out a questionnaire on their quality of life before the procedure and again once a year. About 75% of the patients reported improved scores.
At the time, the surgery was being presented as a treatment, but not a cure, for the disease.
When the chest physicians met again the following fall, the results of the surgery still looked like it was helping patients. Some were able to improve their lung function and ability to exercise, even seeming to do better than those who received standard treatment for the disease.
One surgical team found only 4% of the patients died within six months after the surgery. The death rate among patients getting traditional treatment with medicine was 17%. And the benefits seemed to last for years after the procedure. Again, treatment was focusing around patients with severe emphysema.
But this week, other researchers have said that initial optimism probably went too far.
"There has been a prevailing view -- that I think unfortunately surgeons have contributed to -- that this operation may be a temporary cure for your disease, and it's clear that it's not for this subset of patients," said one of the researchers, Steven Piantadosi, MD, PhD, of Johns Hopkins University.