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Cited by 2,071Chronic Obstructive Pulmonary Disease (COPD) ResearchRespiratory Support and MechanismsTransplantation: Methods and Outcomes

A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema

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National Emphysema Treatment Trial Research Group·2003·New England Journal of Medicine
DOI 10.1056/nejmoa030287
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Abstract

BACKGROUND: Lung-volume-reduction surgery has been proposed as a palliative treatment for severe emphysema. Effects on mortality, the magnitude and durability of benefits, and criteria for the selection of patients have not been established. METHODS: A total of 1218 patients with severe emphysema underwent pulmonary rehabilitation and were randomly assigned to undergo lung-volume-reduction surgery or to receive continued medical treatment. RESULTS: Overall mortality was 0.11 death per person-year in both treatment groups (risk ratio for death in the surgery group, 1.01; P=0.90). After 24 months, exercise capacity had improved by more than 10 W in 15 percent of the patients in the surgery group, as compared with 3 percent of patients in the medical-therapy group (P<0.001). With the exclusion of a subgroup of 140 patients at high risk for death from surgery according to an interim analysis, overall mortality in the surgery group was 0.09 death per person-year, as compared with 0.10 death per person-year in the medical-therapy group (risk ratio, 0.89; P=0.31); exercise capacity after 24 months had improved by more than 10 W in 16 percent of patients in the surgery group, as compared with 3 percent of patients in the medical-therapy group (P<0.001). Among patients with predominantly upper-lobe emphysema and low exercise capacity, mortality was lower in the surgery group than in the medical-therapy group (risk ratio for death, 0.47; P=0.005). Among patients with non-upper-lobe emphysema and high exercise capacity, mortality was higher in the surgery group than in the medical-therapy group (risk ratio, 2.06; P=0.02). CONCLUSIONS: Overall, lung-volume-reduction surgery increases the chance of improved exercise capacity but does not confer a survival advantage over medical therapy. It does yield a survival advantage for patients with both predominantly upper-lobe emphysema and low base-line exercise capacity. Patients previously reported to be at high risk and those with non-upper-lobe emphysema and high base-line exercise capacity are poor candidates for lung-volume-reduction surgery, because of increased mortality and negligible functional gain.

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  • The paper says lung volume reduction can help selected COPD patients and may delay the need for transplant.

    “Lung volume reduction (LVR), performed by either surgical or bronchoscopic approach, is an option for a subset of COPD patients with advanced emphysema who meet strict selection criteria. These procedures have been associated with improved lung function, exercise capacity, and quality of life.(181–183)”

    From Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation. (2021) · cites this paper as [183]

    The Discussion (p. 2071) reports that lung-volume-reduction surgery increased the chance of improved exercise capacity, lung function, and quality of life, with benefits varying by patient subgroup. The Methods (page not supplied) describe surgical approaches, not bronchoscopic reduction, so this paper does not support the sentence’s extension to both approaches. The citing sentence does not make a transplant-delay claim; the Treatment section reports transplant counts but does not establish that surgery delayed transplantation. (LLM, conf=0.87)

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  • In COPD, residual volume and FRC can be increased to 70% and 85% of TLC, respectively.

    “In COPD, these values can be increased to 70% and 85% of the TLC for residual volume and FRC, respectively.143”

    From Pathogenesis of hyperinflation in chronic obstructive pulmonary disease (2014) · cites this paper as [143]

    The Results (Table 1; page not available in our copy) report residual volume and total lung capacity separately as percentages of predicted values, not as the claimed percentages of TLC. The Statistical Analysis section mentions the residual-volume-to-TLC ratio, but our copy gives neither a 70% value for that ratio nor an 85% FRC-to-TLC value (searched: residual volume, functional residual capacity, and the claimed percentages). (LLM, conf=0.76)

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Research works printed but not linked: 2

  1. [12]12. www.nejm.org may 22, 2003 lung-volume-reduction surgery 2073 1995 update. Am J Respir Crit Care Med 1995;152:2185-98.
  2. [22]22. Stata reference manual, version 7. Col- lege Station, Tex.: Stata Press, 2001.

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Authors
National Emphysema Treatment Trial Research Group
Affiliations
University of Pennsylvania (US)
Corresponding author
National Emphysema Treatment Trial Research Group
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2003-05-22
Volume
348
Issue
21
Pages
2059-2073
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa030287
OpenAlex
W2101787490
Semantic Scholar
42daa04270341ebadef5b279af5792858b4ab2f7
Cited by
2,071
References
23
Citations by year
2026: 31 · 2025: 46 · 2024: 66 · 2023: 69 · 2022: 51 · 2021: 67 · 2020: 79 · 2019: 82 · 2018: 89 · 2017: 96 · 2016: 101 · 2015: 83 · 2014: 106 · 2013: 81 · 2012: 121
FWCI
86.25
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (n01hr076109-006, n01hr076108-002, n01hr076114-001, n01hr076105-002, n01hr076104-001, n01hr076107-006, n01hr076112-000, n01hr076110-005, n01hr076118-007, n01hr076111-002, n01hr076119-008, n01hr076102-007, n01hr076115-008, n01hr076116-002, n01hr076101-006, n01hr076113-000, n01hr076106-002, n01hr076103-001)
  • National Heart, Lung, and Blood Institute (N01HR76118, N01 HR 76111, N01-HR76119, N01 HR 76102, N01HR76110, N01 HR 76109, N01 HR 76104, N01HR76106, N01HR76108, N01HR76101, N01HR76115, N01 HR76103, N01 HR 76116, N01HR76114, N01 HR76113, N01HR76112, N01 HR76107, N01 HR 76105)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
  • Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
Keywords
lung volume reduction surgery, severe emphysema, medical therapy, mortality, exercise capacity, pulmonary rehabilitation, upper lobe emphysema, patient selection, surgical risk, palliative care
MeSH terms
Aged, Female, Humans, Male, Middle Aged, Pneumonectomy, Probability, Pulmonary Emphysema, Risk Factors, Logistic Models, Treatment Outcome, Exercise Tolerance

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