Abstract
ObjectivesWe aim to address several clinical interests regarding lung volume reduction surgery (LVRS) for severe emphysema using meta-analysis and systematic review of randomized controlled trials (RCTs).MethodsEight RCTs published from 1999 to 2010 were identified and synthesized to compare the efficacy and safety of LVRS vs conservative medical therapy. One RCT was obtained regarding comparison of median sternotomy (MS) and video-assisted thoracoscopic surgery (VATS). And three RCTs were available evaluating clinical efficacy of using bovine pericardium for buttressing, autologous fibrin sealant and BioGlue, respectively.ResultsOdds ratio (95%CI), expressed as the mortality of group A (the group underwent LVRS) versus group B (conservative medical therapies), was 5.16(2.84, 9.35) in 3 months, 3(0.94, 9.57) in 6 months, 1.05(0.82, 1.33) in 12 months, respectively. On the 3rd, 6th and 12th month, all lung function indices of group A were improved more significantly as compared with group B. PaO2 and PaCO2 on the 6th and 12th month showed the same trend. 6MWD of group A on the 6th month and 12th month were improved significantly than of group B, despite no difference on the 3rd month. Quality of life (QOL) of group A was better than of group B in 6 and 12 months. VATS is preferred to MS, due to the earlier recovery and lower cost. And autologous fibrin sealant and BioGlue seems to be the efficacious methods to reduce air leak following LVRS.ConclusionsLVRS offers the more benefits regarding survival, lung function, gas exchange, exercise capacity and QOL, despite the higher mortality in initial three postoperative months. LVRS, with the optimization of surgical approach and material for reinforcement of the staple lines, should be recommended to patients suffering from severe heterogeneous emphysema.
Highlights
Emphysema is a chronic and progressive disease, characterized by permanent impairment of pulmonary terminal airway, hyperinflation of parenchyma and loss of elastic retraction
Numerous studies have addressed the patients with severe emphysema can receive benefits from lung volume reduction surgery (LVRS), some physicians remain routinely reluctant to recommend LVRS to the suitable patients due to the insufficient published Randomized Clinical Trials (RCTs) evaluating surgical risks and long term sequels [9,10,11,12]
We performed a meta-analysis of randomized controlled trials (RCTs) published in the past 11 years for the sake of evaluating safety, short-term efficacy and long-term sequel of LVRS
Summary
Emphysema is a chronic and progressive disease, characterized by permanent impairment of pulmonary terminal airway, hyperinflation of parenchyma and loss of elastic retraction. The shortness of breath, poor exercise tolerance and impaired health status will occur on the final stage of emphysema [1,2,3]. Numerous studies have addressed the patients with severe emphysema can receive benefits from LVRS, some physicians remain routinely reluctant to recommend LVRS to the suitable patients due to the insufficient published Randomized Clinical Trials (RCTs) evaluating surgical risks and long term sequels [9,10,11,12]. There are controversial points regarding the efficacy and safety of two approaches for LVRS [median sternotomy(MS) vs video-assisted thoracoscopy surgery (VATS)] [13]. We performed a meta-analysis of RCTs published in the past 11 years for the sake of evaluating safety, short-term efficacy and long-term sequel of LVRS. We conduct the systematic review of two approaches (MS vs VATS) and the materials (bovine pericardium for buttressing, autologous fibrin sealant and BioGlue) for LVRS
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