Morphologic Grading of the Emphysematous Lung and Its Relation to Improvement After Lung Volume Reduction Surgery

Wisser, Wilfried; Klepetko, Walter; Kontrus, Manfred; Bankier, Alex; Şenbaklavacı, Ömer; Kaider, Alexandra; Wanke, T.; Tschernko, Edda; Wolner, Ernst

doi:10.1016/s0003-4975(97)01342-8

Cited by 66 publications

(31 citation statements)

References 10 publications

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“…Survival was greatest in the heterogeneous group, but the functional data at onset were best in this group as well. These results were confirmed by WISSER et al [111].…”

Section: Selection Of Candidatessupporting

confidence: 77%

Treatment of chronic respiratory failure: lung volume reduction surgery versus rehabilitation

Decramer¹

2003

European Respiratory Journal

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“…Survival was greatest in the heterogeneous group, but the functional data at onset were best in this group as well. These results were confirmed by WISSER et al [111].…”

Section: Selection Of Candidatessupporting

confidence: 77%

Treatment of chronic respiratory failure: lung volume reduction surgery versus rehabilitation

Decramer¹

2003

European Respiratory Journal

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“…The extent of emphysema was estimated using a scoring system (0 ϭ Ͻ 5% emphysema; 1 ϭ 5-25%; 2 ϭ 25-50%; 3 ϭ 50 -75%; 4 ϭ 75-100%) derived from Bankier and colleagues. [24][25][26] Correlation of scores with clinical data were performed (after image analysis) by another investigator (MB).…”

Section: What This Paper Contributes To Our Knowledgementioning

confidence: 99%

Idiopathic Pulmonary Fibrosis With Emphysema: Evidence of Synergy Among Emphysema and Idiopathic Pulmonary Fibrosis in Smokers

et al. 2014

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BACKGROUND: Emphysema and fibrosis, typically the idiopathic pulmonary fibrosis (IPF) form of usual interstitial pneumonia (UIP), can co-exist as combined pulmonary fibrosis emphysema (CPFE). It is unknown whether there is a pathobiologic basis for CPFE beyond the coexistence of fibrosis and emphysema. The aim of this study was to ascertain radiologic differences in severity of fibrosis and emphysema in smokers with IPF versus other forms of UIP. METHODS: Computed tomography thorax images were prospectively rescored in retrospectively identified smokers (minimum 5-pack-year history) with radiologic UIP (any etiology). Radiologic severity (emphysema/fibrosis/reticulation) was scored in consensus by two radiologists, blinded to clinical details, across 5 lung regional levels, and then correlated with clinical data. RESULTS: For the whole cohort (IPF, n ‫؍‬ 102; non-IPF UIP [mainly rheumatoid arthritis/asbestosis/scleroderma], n ‫؍‬ 30), IPF and non-IPF UIP smokers were similar regarding pack-year, age, gender, and lung function (P > .1). IPF smokers had greater whole lung fibrosis and reticulation scores (P < .04 in all cases). CPFE was present in n ‫؍‬ 61 (IPF, n ‫؍‬ 49; non-IPF UIP, n ‫؍‬ 12). Compared with smokers with non-IPF CPFE, smokers with IPF and emphysema (IPFE) were similar regarding confounders (P > .1). There were significantly greater regional reticulation severity (P ‫؍‬ .009), cumulative emphysema severity (P ‫؍‬ .04), and cumulative reticulation severity (P < .001) scores in IPFE versus non-IPF CPFE. CONCLUSIONS: When controlled for confounders, smokers with IPFE have worse radiologic CPFE than other smokers with non-IPF UIP and emphysema, suggesting an interactive synergy among IPF, emphysema, and smoking, with more extensive emphysema due to either inherent susceptibility and/or traction effects. IPFE should be considered separately from other CPFE in future work. It is currently unknown whether CPFE is a distinct pathobiologic entity; therefore, we identified subjects with radiologic UIP (any etiology) who had been similarly exposed to smoke, and asked whether there are differences in the extent/severity of radiologic fibrosis and/or emphysema in those with IPF versus individuals with non-IPF UIP. Although relevant confounders were similar, IPF smokers had greater whole lung fibrosis and reticulation scores than smokers with secondary forms of UIP, and in the CPFE subgroup, smokers with IPF/emphysema had worse radiologic CPFE findings than smokers with non-IPF UIP/emphysema. It is shown for the first time that relevant confounding variables do not explain the observed excess radiologic severity of emphysema and fibrosis in smokers with IPF compared with smokers with non-IPF UIP, lending support to the hypothesis that there is a pathobiologic mechanism or synergy involved in IPF with emphysema that is distinct from the mere co-existence of UIP and emphysematous processes.

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“…Identification of factors that accurately and consistently predict adverse outcome is necessary to develop evidence-based exclusion criteria. Many series of LVRS have reported a variety of demographic, radiologic, and/or physiologic characteristics that predicted higher operative risk (Table 4) (9,(30)(31)(32)(33)(34)(35)(36)(37)(38)(39). Unfortunately, most were small, retrospective, single-institution, case-controlled series with selection bias and incomplete or inconsistent data collection.…”

Section: Mortalitymentioning

confidence: 99%

Lung Volume Reduction Surgery: Technique, Operative Mortality, and Morbidity

DeCamp¹,

McKenna²,

Deschamps³

et al. 2008

Proceedings of the American Thoracic Society

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The objective of lung volume reduction surgery (LVRS) is the safe, effective, and durable palliation of dyspnea in appropriately selected patients with moderate to severe emphysema. Appropriate patient selection and preoperative preparation are prerequisites for successful LVRS. An effective LVRS program requires participation by and communication between experts from pulmonary medicine, thoracic surgery, thoracic anesthesiology, critical care medicine, rehabilitation medicine, respiratory therapy, chest radiology, and nursing. The critical analysis of perioperative outcomes has influenced details of the conduct of the procedure and has established a bilateral, stapled approach as the standard of care for LVRS. The National Emphysema Treatment Trial (NETT) remains the world's largest multi-center, randomized trial comparing LVRS to maximal medical therapy. NETT purposely enrolled a broad spectrum of anatomic patterns of emphysema. This, along with the prospective, audited collection of extensive demographic, physiologic, radiographic, surgical and quality-of-life data, has positioned NETT as the most robust repository of evidence to guide the refinement of patient selection criteria for LVRS, to assist surgeons in providing optimal intraoperative and postoperative care, and to establish benchmarks for survival, complication rates, return to independent living, and durability of response. This article reviews the evolution of current LVRS practice with a particular emphasis on technical aspects of the operation, including the predictors and consequences of its most common complications.Keywords: emphysema; surgery; complications; outcomes Pneumectomy or the nonanatomic resection of emphysematous lung by thoracotomy to palliate chronic dyspnea was proposed and tested by Otto Brantigan in the 1950s (1). While the physiologic principles of the procedure appeared to benefit survivors, operative morbidity and mortality proved prohibitive and relegated the procedure to the obscure pages of the history of surgery for emphysema, where it lay alongside costochondrectomy, phrenic nerve lysis, and glomectomy (2). Joel Cooper and colleagues resurrected the concept of partial pneumectomy nearly four decades later, advocating a bilateral, nonanatomic, stapled resection through a median sternotomy. Forty years of advances in anesthesia, critical care, pulmonary rehabilitation, and surgical instrumentation, along with the expertise of the Washington University group, yielded a considerable reduction in operative morbidity and mortality, and lung volume reduction surgery (LVRS) was (re)born (3).The objective of LVRS is the safe, effective, and durable palliation of dyspnea in appropriately selected patients with moderate to severe emphysema. Before the National Emphysema Treatment Trial (NETT), there were several reported single institutional, case-controlled series of LVRS demonstrating encouraging results with regard to mean improvements in spirometry, 6-minute-walk distance, self-reported dyspnea, and supplemental oxygen use (...

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Morphologic Grading of the Emphysematous Lung and Its Relation to Improvement After Lung Volume Reduction Surgery

Cited by 66 publications

References 10 publications

Treatment of chronic respiratory failure: lung volume reduction surgery versus rehabilitation

Treatment of chronic respiratory failure: lung volume reduction surgery versus rehabilitation

Idiopathic Pulmonary Fibrosis With Emphysema: Evidence of Synergy Among Emphysema and Idiopathic Pulmonary Fibrosis in Smokers

Lung Volume Reduction Surgery: Technique, Operative Mortality, and Morbidity

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