Medical Health Encyclopedia

The most recent NETT results indicate that surgical patients who had emphysema in the upper lungs and a low exercise capacity may have better survival rates and outcome than the same patient group given medical therapy. More research is needed to confirm these findings.

Comparison in Outcomes Between Surgery and Medical Treatments
	Low Exercise Capacity	Text Continues Below High Exercise Capacity
Emphysema in Upper Lungs	Surgical group had better function and two-year survival rates than medical group.	Similar mortality rates but surgery group had better function.
Emphysema Not in the Upper Lungs	Similar survival rates and similar outcome.	Surgical group had worse survival rates and both had low chance for improving in function.
Data from: A Randomized Trial Comparing Lung-Volume-Reduction Surgery with Medical Therapy for Severe Emphysema. The New England Journal of Medicine. May 22, 2003. No. 21, Vol. 348.

Poor Candidates for Surgery. Early results from NETT suggest that the following patients have a high risk for a poor outcome and are generally not good candidates:

• Those with a very low FEV1 (less than 20% of expected value), plus
• Those with carbon monoxide diffusing capacity of less than 20% of expected value, or
• Those with uniform distribution of emphysema in the lungs.

In the study, patients with these characteristics had a 16% mortality rate at 30 days after surgery compared to no deaths in similar patients who were treated with medications only. Such high-risk patients accounted for about 12.5% of the patient population in the study.

Patients may also be excluded if they have severe medical conditions that limit their life span; severe psychological problems; recent tobacco, drug, or alcohol dependence; chest wall deformity; corticosteroid dependence; or scarring around the membrane of the lung. Other indicators for a poor outlook include severe lung complications and isolated bullae (air pockets in diseased area of the lungs).