With regard to lung volume reduction surgery (LVRS) for emphysema, the ICSI Technology Assessment Committee finds:
Overall, LVRS did not demonstrate a survival advantage over medical therapy. LVRS only yielded a survival advantage for patients with upper lobe emphysema and low baseline exercise capacity. LVRS demonstrated increased mortality and no functional gain for patients with non-upper lobe emphysema (Conclusion Grade II).
LVRS only showed improvement in exercise capacity among a small subgroup of patients: those with upper lobe emphysema. Most patients improvements returned to baseline after 2 years (Conclusion Grade II).
Significantly more patients with upper lobe emphysema randomized to LVRS had improved quality of life after 2 years as compared to non-surgical patients.
Due to the strictness of the exclusion criteria, conclusions from the NETT trial cannot be extended to the general population of patients with emphysema.
Pre-operative evaluation includes: ability to complete a 6 minute walk of over 140 meters, completion of a pulmonary rehabilitation program, full pulmonary function tests, chest CT, echocardiogram, and possibly a right heart catheterization and a radionuclide stress test.
LVRS should only be performed in medical centers with appropriately trained surgeons and availability of necessary equipment.