Lung reduction surgery for emphysema does not help the sickest patients, according to the latest report.
In emphysema, the air sacs of the lungs - the alveoli - are progressively destroyed, leaving the patient so short of breath that they cannot do everyday activities like climbing stairs or carrying their shopping. In the mid-1990s, studies seemed to suggest that lung reduction surgery was beneficial for people with emphysema. It appeared to leave them with a smaller, but more efficient, lung by cutting out a lot of the diseased tissue.
Following this report, the demand for surgery increased enormously and the National Institutes of Health launched further trials to see if the operation was really effective. People had either surgery or standard medical management for their condition. The first report of the trial now urges caution over surgery. The sickest patients - those with the worst lung function- have a higher risk of death within 30 days of the operation compared to those who don't have surgery. Whether those who survive surgery will do better than those on medical management in the long term remains to be seen. In the meantime, it appears that surgery should not be regarded as a universal solution for emphysema.