Original Articles
Four-Year Results After Lung Volume Reduction Surgery for Emphysema
G. Juan Sampera,
, M. Ramón Capillab, A. Cantó Armengolc, M.L. Martínez Pérezb, T. Lloret Pérezb, E. Rubio Gomisd, J. Marín Pardoa
Corresponding author
gustavo.juan@uv.es
Correspondence: Prof. G. Juan Samper. Unidad de Neumología. Departamento de Medicina. Facultad de Medicina. Universidad de Valencia. Avda. Blasco Ibáñez, 15. 46010 Valencia. España
Correspondence: Prof. G. Juan Samper. Unidad de Neumología. Departamento de Medicina. Facultad de Medicina. Universidad de Valencia. Avda. Blasco Ibáñez, 15. 46010 Valencia. España
a Unidad de Neumología, Departamento de Medicina, Facultad de Medicina, Universidad de Valencia, Valencia, Spain
b Servicio de Neumología, Hospital General Universitario, Valencia, Spain
c Servicio de Cirugía de Tórax, Hospital General Universitario, Valencia, Spain
d Departamento de Farmacología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain
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"apellidos" => "Juan Samper" "email" => array:1 [ 0 => "gustavo.juan@uv.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Ramón Capilla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Cantó Armengol" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] ] 3 => array:3 [ "nombre" => "M.L." "apellidos" => "Martínez Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 4 => array:3 [ "nombre" => "T." 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"apellidos" => "Marín Pardo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Unidad de Neumología, Departamento de Medicina, Facultad de Medicina, Universidad de Valencia, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Servicio de Neumología, Hospital General Universitario, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Servicio de Cirugía de Tórax, Hospital General Universitario, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] 3 => array:3 [ "entidad" => "Departamento de Farmacología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff4" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Prof. G. Juan Samper. Unidad de Neumología. Departamento de Medicina. Facultad de Medicina. Universidad de Valencia. Avda. Blasco Ibáñez, 15. 46010 Valencia. España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2003-12-12" "fechaAceptado" => "2004-04-20" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key Words" "identificador" => "xpalclavsec153126" "palabras" => array:5 [ 0 => "Lung volume reduction" 1 => "Emphysema surgery" 2 => "Dyspnea" 3 => "Quality of Life" 4 => "Survival" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec153127" "palabras" => array:5 [ 0 => "Neumorreducción" 1 => "Cirugía del enfisema" 2 => "Disnea" 3 => "Calidad de vida" 4 => "Supervivencia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p class="elsevierStyleSimplePara elsevierViewall">While the short-term results of lung volume reduction surgery are known, follow-up over several years has not often been described. The purpose of the present study was to describe results in terms of functional improvement, dyspnea, quality of life, and mortality over a 4-year period in patients with advanced emphysema.</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">Fourteen successive patients were enrolled between 1996 and 2000 and studied prospectively for 4 years. All patients served as their own controls and initially received pulmonary rehabilitation and medication. Preoperative data were used as baseline and were compared to postoperative data over 4 years. The data analyzed were: functional improvement (forced expiratory volume in 1 second [FEV<span class="elsevierStyleInf">1</span>]), quality of life, dyspnea, and patient loss due to death or referral to a lung transplantation program.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Patients with advanced emphysema (mean FEV<span class="elsevierStyleInf">1</span> [SD]: 22.8% [11%] of predicted) were studied. Postoperative mortality was 14%. Overall mortality (postoperative plus deaths due to respiratory insufficiency) was 28% at 1 year and 35% at 4 years. Two patients died of cancer and 5 were referred for transplantation. At 3 months, FEV<span class="elsevierStyleInf">1</span> had improved more than 15% in 9 patients (64%); the improvement was maintained in 43% of patients at 1 year and 7% at 4 years. Improvement in dyspnea paralleled improvement in FEV<span class="elsevierStyleInf">1</span>. Overall, at 3 months mean FEV<span class="elsevierStyleInf">1</span> had improved 41.9% (68%), transitional dyspnea index 2.7 (3), and quality of life questionnaire score 1 (0.9). Thus, improvements were considerable, but there was great variation. Preoperative mean decrease in FEV<span class="elsevierStyleInf">1</span> was 50 (32) mL/y, and postoperative decrease 194 (70) mL/y.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">With the inclusion criteria used, there was considerable variation in the results. Significant overall functional improvement was maintained in 50% of the patients 1 year following surgery and in 7% 4 years after surgery. Given such results, together with a surgical mortality rate of 14% and overall mortality of 28% in the first year, we believe that the criteria for using lung reduction surgery should be revised.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p class="elsevierStyleSimplePara elsevierViewall">Aunque se conocen los resultados de la cirugía de reducción de volumen a corto plazo, son pocas las series que describen el seguimiento durante varios años. El propósito de este estudio es describir los resultados, en relación con la mejoría funcional, disnea, calidad de vida y mortalidad, a lo largo de 4 años en pacientes con enfisema avanzado.</p> <span class="elsevierStyleSectionTitle">Pacientes Y Métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Se ha estudiado de forma prospectiva a 14 pacientes incluidos sucesivamente entre los años 1996 y 2000, y seguidos a lo largo de 4 años. Cada paciente fue su propio control y recibió inicialmente tratamiento rehabilitador y farmacológico. Se utilizaron los datos preoperatorios como basales y se compararon con los postoperatorios a lo largo de 4 años. Los datos analizados fueron: mejoría mecánica —volumen espiratorio forzado en el primer segundo (FEV<span class="elsevierStyleInf">1</span>)—, calidad de vida, disnea y pérdida del paciente, tanto por fallecimiento como por remitirlo a un programa de trasplante pulmonar.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Se incluyó a pacientes con enfisema avanzado (FEV<span class="elsevierStyleInf">1</span>: 22,8 ± 11%). La mortalidad postoperatoria fue del 14% y, unida a la originada por la insuficiencia respiratoria, del 28 y el 35% al año y a los 4 años, respectivamente. Dos pacientes murieron por cáncer y 5 se remitieron a trasplante. A los 3 meses, 9 pacientes (64%) habían mejorado más del 15% el FEV<span class="elsevierStyleInf">1</span> y esta mejoría se mantuvo en el 43% al año y en el 7% a los 4 años. La mejoría de la disnea fue paralela a la mejoría del FEV<span class="elsevierStyleInf">1</span>. Globalmente, a los 3 meses el FEV<span class="elsevierStyleInf">1</span> había mejorado un 41,9 ± 68%, el índice transicional de disnea un 2,7 ± 3 y la calidad de vida 1 ± 0,9, es decir, mejorías importantes pero con mucha dispersión. La caída del FEV<span class="elsevierStyleInf">1</span> prequirúrgica fue de 50 ± 32 ml/año, y la posquirúrgica de 194 ± 70 ml/año.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Con los criterios de inclusión seguidos, hay una importante variabilidad en los resultados y, globalmente, se mantiene una mejoría funcional significativa en el 50% de los pacientes al año de la cirugía y del 7% a los 4 años. Estos hechos, unidos a una mortalidad operatoria del 14% y global del 28% en el primer año, hacen que se tengan que revisar los criterios de indicación de esta cirugía.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognosis in chronic obstructive pulmonary diseases: results from multicenter trials" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "NF Anthonisen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am Rev Respir Dis" "fecha" => "1989" "volumen" => "140" "paginaInicial" => "595" "paginaFinal" => "599" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 1 | 5 |
| 2024 October | 27 | 13 | 40 |
| 2024 September | 27 | 13 | 40 |
| 2024 August | 33 | 33 | 66 |
| 2024 July | 21 | 20 | 41 |
| 2024 June | 30 | 22 | 52 |
| 2024 May | 33 | 31 | 64 |
| 2024 April | 14 | 23 | 37 |
| 2024 March | 18 | 13 | 31 |
| 2024 February | 19 | 18 | 37 |
| 2023 March | 5 | 4 | 9 |
| 2023 February | 14 | 22 | 36 |
| 2023 January | 14 | 26 | 40 |
| 2022 December | 17 | 24 | 41 |
| 2022 November | 19 | 25 | 44 |
| 2022 October | 18 | 25 | 43 |
| 2022 September | 15 | 20 | 35 |
| 2022 August | 16 | 34 | 50 |
| 2022 July | 18 | 44 | 62 |
| 2022 June | 16 | 37 | 53 |
| 2022 May | 17 | 36 | 53 |
| 2022 April | 15 | 25 | 40 |
| 2022 March | 19 | 42 | 61 |
| 2022 February | 17 | 32 | 49 |
| 2022 January | 15 | 37 | 52 |
| 2021 December | 14 | 45 | 59 |
| 2021 November | 15 | 32 | 47 |
| 2021 October | 39 | 34 | 73 |
| 2021 September | 31 | 41 | 72 |
| 2021 August | 31 | 48 | 79 |
| 2021 July | 13 | 27 | 40 |
| 2021 June | 15 | 30 | 45 |
| 2021 May | 11 | 22 | 33 |
| 2021 April | 19 | 21 | 40 |
| 2021 March | 16 | 20 | 36 |
| 2021 February | 4 | 9 | 13 |
| 2021 January | 4 | 15 | 19 |
| 2020 December | 13 | 13 | 26 |
| 2020 November | 8 | 12 | 20 |
| 2020 October | 4 | 10 | 14 |
| 2020 September | 6 | 1 | 7 |
| 2020 August | 4 | 9 | 13 |
| 2020 July | 9 | 12 | 21 |
| 2020 June | 11 | 6 | 17 |
| 2020 May | 14 | 16 | 30 |
| 2020 April | 8 | 8 | 16 |
| 2020 March | 8 | 13 | 21 |
| 2020 February | 8 | 12 | 20 |
| 2020 January | 13 | 14 | 27 |
| 2019 December | 12 | 15 | 27 |
| 2019 November | 9 | 11 | 20 |
| 2019 October | 5 | 10 | 15 |
| 2019 September | 4 | 14 | 18 |
| 2019 August | 9 | 7 | 16 |
| 2019 July | 7 | 12 | 19 |
| 2019 June | 6 | 7 | 13 |
| 2019 May | 9 | 13 | 22 |
| 2019 April | 9 | 16 | 25 |
| 2019 March | 9 | 19 | 28 |
| 2019 February | 6 | 12 | 18 |
| 2019 January | 4 | 7 | 11 |
| 2018 December | 7 | 18 | 25 |
| 2018 November | 15 | 6 | 21 |
| 2018 October | 25 | 21 | 46 |
| 2018 September | 7 | 19 | 26 |
| 2018 May | 5 | 0 | 5 |
| 2018 April | 11 | 7 | 18 |
| 2018 March | 3 | 2 | 5 |
| 2018 February | 2 | 5 | 7 |
| 2018 January | 7 | 10 | 17 |
| 2017 December | 6 | 4 | 10 |
| 2017 November | 2 | 4 | 6 |
| 2017 October | 8 | 12 | 20 |
| 2017 September | 7 | 4 | 11 |
| 2017 August | 10 | 18 | 28 |
| 2017 July | 3 | 8 | 11 |
| 2017 June | 10 | 24 | 34 |
| 2017 May | 9 | 15 | 24 |
| 2017 April | 3 | 5 | 8 |
| 2017 March | 2 | 32 | 34 |
| 2017 January | 1 | 4 | 5 |
| 2016 December | 12 | 12 | 24 |
| 2016 November | 11 | 8 | 19 |
| 2016 October | 13 | 7 | 20 |
| 2016 September | 12 | 17 | 29 |
| 2016 August | 14 | 5 | 19 |
| 2016 July | 7 | 8 | 15 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 40 | 1 | 41 |
| 2015 September | 46 | 9 | 55 |
| 2015 August | 46 | 9 | 55 |
| 2015 July | 38 | 6 | 44 |
| 2015 June | 26 | 4 | 30 |
| 2015 May | 53 | 6 | 59 |
| 2015 April | 38 | 11 | 49 |
| 2015 March | 40 | 5 | 45 |
| 2015 February | 35 | 2 | 37 |
| 2015 January | 35 | 7 | 42 |
| 2014 December | 39 | 5 | 44 |
| 2014 November | 32 | 4 | 36 |
| 2014 October | 58 | 10 | 68 |
| 2014 September | 39 | 7 | 46 |
| 2014 August | 40 | 6 | 46 |
| 2014 July | 41 | 11 | 52 |
| 2014 June | 52 | 4 | 56 |
| 2014 May | 50 | 7 | 57 |
| 2014 April | 45 | 5 | 50 |
| 2014 March | 59 | 9 | 68 |
| 2014 February | 46 | 8 | 54 |
| 2014 January | 46 | 4 | 50 |
| 2013 December | 40 | 12 | 52 |
| 2013 November | 26 | 6 | 32 |
| 2013 October | 28 | 7 | 35 |
| 2013 September | 42 | 9 | 51 |
| 2013 August | 33 | 6 | 39 |
| 2013 July | 44 | 15 | 59 |
| 2013 June | 33 | 6 | 39 |
| 2013 May | 32 | 7 | 39 |
| 2013 April | 18 | 5 | 23 |
| 2013 March | 7 | 2 | 9 |
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