The Dangers of Emphysema Surgery
Oct. 10, 2001 -- A popular surgery for emphysema might not be so popular anymore, since researchers who reviewed the results of the operation found the procedure could be dangerous and even deadly to those with severe cases of the disease.
The news was pressing enough for the researchers to jump the gun and announce the results of the lung-surgery study in August. The researchers have officially released their findings in the Oct. 11 issue of The New England Journal of Medicine.
Lung damage from emphysema is primarily tied to smoking, and each year it strikes about 2 million Americans. Doctors had been trying to determine if it would be helpful to take out parts of the damaged lung tissue to treat some of these people.
The National Institutes of Health started to investigate and found that when people with severe forms of the disease had the surgery, 16% died within a month of the operation. In contrast, none of the 70 patients treated with medication and diet died within the first four weeks of their treatment.
The new study found that over three years, surgery patients were four times more likely to die than the other group getting more conservative treatment. Also, those who survived the surgery saw only small improvement in their breathing or quality of life.
In August, researchers severely restricted the number of patients who could get the surgery, limiting it to about 1,000 emphysema patients who might still benefit from it.
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 doctors met again the following fall, the results of the surgery still looked like it was helping people. 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.
By this past summer, other researchers determined the initial optimism probably went too far. Still, the procedure's supporters stood by the surgery, noting the more recent trials had not chosen appropriate participants carefully enough.
The technique has become widespread in recent years, with around 8,000 operations performed every year.