Less Invasive Emphysema Treatment Appears Just as Effective as Keyhole Surgery

A recent study presented at the European Respiratory Society International Congress in Barcelona, Spain, compared results from invasive and noninvasive emphysema treatments, finding similar improvements in patient lung function, breathlessness, and exercise capacity.¹

Lung volume reduction surgery (LVRS) is a keyhole operation into the chest to access the lungs and clear out the part of the lungs most effected by emphysema. Bronchoscopic lung volume reduction (BVLR) is a noninvasive process that uses a fiber optic camera inserted into the lungs though the nose or mouth. One-way valves are then placed in the targeted lobe of the lung to deflate it almost completely.

BVLR has been known in the medical profession to be less risky than LVRS. However, some medical professionals believe not enough research has been done in evaluating the risk factors and efficacy of BVLR compared with LVRS.

Nicknamed the CELEB trial (Comparative Effectiveness of Lung volume reduction surgery for Emphysema and Bronchoscopic lung volume reduction with valve placement), this randomized controlled single-blind superiority study aimed to find out if LVRS was more effective in treating patients with emphysema than BVLR. The study was comprised of 88 randomized patients with an average age of 64 years. The group was then split into 2 groups, a BLVR group (n = 47) and an LVRS group (n = 41).

The study was able to measure the patient’s response to treatment using iBODE score, which is comprised of body mass index, airflow obstruction, breathlessness, and exercise capacity. Additionally, the researchers evaluated change in residual volume (RV%), which measures the amount of gas trapping in which excess air is left in the lungs after exhalation.

At a 12-month follow-up, iBODE scores in both the LVRS and BVLR groups improved to a similar extent (LVRS: –1.10 [1.44]; BVLR: –0.82 [1.61]; P = .54). Similar results were presented for RV (LVRS: –36.1 [–54.1 to –10]; BVLR: –30.5 [–59.0 to –9]; P = .91). Additionally, survival did not differ between groups, with 1 death in each arm, over the 12 months (EBV: 3 months, LVRS: 6 months).

The researchers found no evidence that LVRS was significantly better than BLVR in treating patients with emphysema.

“The results of this study will be important for clinicians and patients in guiding decision-making around which treatment option to choose when a person is suitable for either approach, providing more evidence around expected outcomes and risks,” investigator Sara Buttery, a research physiotherapist and PhD candidate at the National Heart and Lung Institute, Imperial College London, said in a news release.²

She added that further studies may help answer questions that this study did not address, such as the cost-benefit of BLVR compared with LVRS. Additionally, larger studies may be able to identify characteristics that would make a patient respond better to one treatment over the other.

“Lung volume reduction surgery is an invasive operation as it requires a small incision to be made in chest, which is stitched up after the procedure. As such, it has risks associated with surgery and it takes longer to recover from than bronchoscopic lung volume reduction,” Alexander Mathioudakis, MD, PhD, National Institute for Health and Care Research clinical lecturer in respiratory medicine at the University of Manchester and secretary of the ERS Airway Pharmacology and Treatment Group, said in the release. “On the other hand, endobronchial valves placement is also associated with side effects, such as pneumonia, or valve displacement. Therefore, both the safety and effectiveness of the two procedures need to be investigated further, in larger groups of patients, but the results from this trial are very encouraging.”

References

1. ALERT 4: asthma and interventional pulmonology. Presented at: European Respiratory Society International Congress; September 6, 2022; Barcelona, Spain. Accessed November 1, 2022. https://k4.ersnet.org/prod/v2/Front/Program/Session?e=377&session=14238.

1. European Lung Foundation. Less invasive treatment for emphysema is as good as more invasive surgery: results from first randomized controlled trial comparing lung volume surgery and bronchoscopic lung volume reduction with valve placement. EurekAlert! September 6, 2022. Accessed November 1, 2022. https://www.eurekalert.org/news-releases/963652