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Lung-Volume Reduction Surgery for End-Stage Chronic Obstructive Pulmonary Disease

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Title: Lung-Volume Reduction Surgery for End-Stage Chronic Obstructive Pulmonary Disease.

Agency: Agency for Health Care Policy and Research/Center for Health Care Technology (formerly the Office of Health Technology Assessment).

Contact: Thomas V. Holohan, M.D., FACP, and Harry Handelsman, D.O.

Status: Technology Assessment: Published, September 1996.

Language: English.

Primary Objective: To assess the technique of lung-volume reduction surgery for end-stage chronic obstructive pulmonary disease patients.

Methods Used: Review of published literature, collection of information from major institutions and Federal agencies and interested parties in response to a Federal Register notice of intent to undertake assessment.

Data Identification: In addition to published data, 27 institutions responded to the solicitation and provided opinion, information, or draft reports.

Study Selection: Editorials; published and unpublished case series, including cost data; description of various surgical techniques; dyspnea indices, 6-min walk data, and oxygen use; pre-and post-operative pulmonary function studies; patient inclusion and exclusion criteria, morbidity and mortality during surgery and 3-12 month followup. A total of 90 published articles were included in the assessment bibliography.

Data Extraction: Type of study; type of surgery; size of sample; patient selection criteria; morbidity and mortality; effectiveness measures (including quality of life).

Key Findings: Patient selection criteria were heterogeneous, and disagreements exist as to the most appropriate surgical techniques for various categories of patients. Followup data are meagre. Improvement in survival has yet to be demonstrated, and pulmonary function tests have not been shown to be reliable surrogates for postoperative survival. An undefinable proportion of patients appear to have realized some benefit from the procedure, although in some cases it is difficult to isolate the proportion of benefit derived from pulmonary rehabilitation in patients to whom it was applied. A prospective trial of lung-volume reduction surgery under uniform protocol requirements is ethically supportable and scientifically essential.

Conclusion: The current data do not permit a logical and scientifically defensible conclusion regarding the risks and benefits of lung-volume reduction surgery.

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