Impact of the type of initial intervention on the outcomes of lung volume reduction for emphysema: a propensity matched study

Vasileios Kouritas; Peter Tcherveniakov; Richard Milton; Kostas Papagiannopoulos; Alessandro Brunelli; Shishir Karthik; Doytchin Dimov; Emmanouel Kefaloyannis; Nilanjan Chaudhuri

doi:10.21037/atm-22-2429

Impact of the type of initial intervention on the outcomes of lung volume reduction for emphysema: a propensity matched study

Ann Transl Med. 2022 Dec;10(23):1275. doi: 10.21037/atm-22-2429.

Authors

Vasileios Kouritas¹, Peter Tcherveniakov², Richard Milton², Kostas Papagiannopoulos², Alessandro Brunelli², Shishir Karthik³, Doytchin Dimov⁴, Emmanouel Kefaloyannis², Nilanjan Chaudhuri²

Affiliations

¹ Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, UK.
² Department of Thoracic Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
³ Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
⁴ Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.

Abstract

Background: The type of initial intervention i.e., endobronchial valve (EBV) implantation or lung volume reduction surgery (LVRS) to be offered as initial intervention remains vague in the treatment of emphysema-chronic obstructive pulmonary disease (COPD) patients. Aim of the present study was to compare the outcomes of EBV with that of LVRS in emphysema patients who could have both offered as an initial intervention.

Methods: The outcomes of 44 EBV patients were retrospectively compared to the outcomes of 44 matched LVRS patients (matched for age, gender, performance status, body mass index (BMI), lung functions, comorbidities and exercise tolerance, matching tolerance 0.2) treated in a single institute within a 5-year period. The median follow-up was 32 months (maximum duration 84 months).

Results: Mean age was 61.91±9.48 years and 55 (62.5%) were male. Postoperative morbidity was similar but length of stay (LOS) was longer in the LVRS group (median 10 vs. 6 days, P=0.006). Re-interventions were more frequent in the EBV versus LVRS group (52.3% vs. 20.5%, P=0.002) and so was the overall number of re-interventions (median 2 vs. 1, P<0.01). Breathing improved in more LVRS patients (86.4% vs. 70.5%, P<0.002). The decrease of the COPD Assessment Test (CAT) score was less significant in the EBV group (P=0.034). Survival was similar between 2 groups (P=0.350).

Conclusions: EBV or LVRS as initial intervention are similar in terms of morbidity and mortality. EBV showed shorter LOS whilst LVRS necessitated less but more severe re-interventions and led to better overall quality of life.

Keywords: Emphysema; chronic obstructive pulmonary disease (COPD); endobronchial valve implantation (EBV); initial; lung volume reduction surgery (LVRS).