LUNG VOLUME REDUCTION SURGERY

Transcription

1 LUNG VOLUME REDUCTION SURGERY

2 LUNGVOLUME REDUCTION SURGERY Edited by MICHAEL ARGENZIANO, MD MARK E. GINSBURG, MD Columbia University College of Physicians and Surgeons; The New York Presbyterian Hospital-Columbia Presbyterian Center, New York, NY SPRINGER SCIENCE+BUSINESS MEDIA,LLC

3 2002 Springer Science+Business Media New York Originally published by Humana Press Inc. in 2002 Softcover reprint of the hardcover 1st edition 2002 All rights reserved. Due diligence has been taken by the publishers, editors, and authors of this book to assure the accuracy of the information published and to describe generally accepted practices. The contributors herein have carefully checked to ensure that the drug selections and dosages set forth in this text are accurate and in accord with the standards accepted at the time of publication. Notwithstanding, as new research, changes in government regulations, and knowledge from clinical experience relating to drug therapy and drug reactions constantly occurs, the reader is advised to check the product information provided by the manufacturer of each drug for any change in dosages or for additional warnings and contraindications. This is of utmost importance when the recommended drug herein is a new or infrequently used drug. It is the responsibility of the treating physician to determine dosages and treatment strategies for individual patients. Further it is the responsibility of the health care provider to ascertain the Food and Drug Administration status of each drug or device used in their clinical practice. The publisher, editors, and authors are not responsible for errors or omissions or for any consequences from the application of the information presented in this book and make no warranty, express or implied, with respect to the contents in this publication. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise without written permission from the Publisher. All articles, comments, opinions, conclusions, or recommendations are those of the author(s), and do not necessarily reflect the views of the publisher. Cover Illustration: Diffuse severe pulmonary emphysema in a 66-year-old man. See Fig. 3 on p. 68. Cover design by Patricia F. Cleary. Production Editor: Mark J. Breaugh. This publication is printed on acid-free paper. ANSI Z (American National Standards Institute) Permanence of Paper for Printed Library Materials. Photocopy Authorization Policy: Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, Springer Science+Business Media, LLC, provided that the base fee of US $10.00 per copy, plus US $00.25 per page, is paid directly to the Copyright Clearance Center at 222 Rosewood Drive, Danvers, MA For those organizations that have been granted a photocopy license from the CCC, a separate system of payment has been arranged and is acceptable to Springer Science+Business Media, LLC. The fee code for users of the Transactional Reporting Service is: [ /02 $ $00.25] I Library of Congress Cataloging-in-Publication Data Lung volume reduction surgery / [edited by] Michael Argenziano, Mark E. Ginsburg p.;cm. Includes bibliographical references and index. ISBN ISBN (ebook) DOI / I. Pneumonectomy. 2. Lungs--Surgery. 3. Emphysema, Pulmonary--Treatment. I. Argenziano, Michael. II. Ginsburg, Mark E. [DNLM: 1. Pneumonectomy. WF 668 L ] RD539.L '42--dc

4 DEDICATIONS To my parents, Anna and Gaetano, who set me upon my current path; and to my wife, Maria, and our sons, Michael, Anthony, and Nicholas, who have made it worth traveling. -Michael Argenziano, MD To honor my parents Jeanne and Ben; and for my wife, Gail, and my children, Adam, Allison, Kerry, and Rebecca: may all your dreams come true. -Mark E. Ginsburg, MD

5 PREFACE In a landmark paper published in 1995, Dr. Joel Cooper reported the initial results of a procedure that he termed "bilateral pneumectomy." A modem reincarnation of an operation conceived nearly a half century earlier by Otto Brantigan, Dr. Cooper's technique involved bilateral resection of significant amounts of diseased lung tissue in emphysema patients, in an effort to improve respiratory function by decompressing the thoracic cavity and increasing pulmonary elastic recoil. Almost instantaneously, worldwide interest and enthusiasm were directed toward this potential panacea for the millions of patients suffering and dying from end-stage emphysema. Lung volume reduction surgery (L VRS), as the new procedure soon came to be known, became the subject of numerous articles in the lay media, if not in scientific journals, gaining the attention of patients, physicians, and the general public. Despite a paucity of objective data, surgeons willing to perform the procedure were inundated by hundreds of selfreferring patients desperate for a new lease on life. Dozens of centers began to perform L VRS, in the manner described by Cooper, and a trickle of scientific reports eventually ensued. According to these early reports, short-term results were promising, although outcomes had not been positive in all patients. Nonetheless, before long, the operation was being performed across the country, fueled by positive reports from centers operating on highly selected patient cohorts, and more importantly, by patient and physician enthusiasm. This enthusiasm for LVRS had several effects. Almost suddenly, questions about how our society should implement new surgical technology and about the role of insurers in determining coverage, and thereby access, to new procedures became central issues. The ethics of randomized trials for the study of apparently beneficial surgical treatments became hotly debated. Fundamental questions were raised concerning the long-term efficacy, cost-effectiveness, selection criteria, timing, and optimal surgical approaches for LVRS. The previously quiescent field of pulmonary physiology was reinvigorated. In 1996, after a review of preliminary data failed to provide conclusive evidence of a clear benefit of L VRS for emphysema, the Health Care Financing Administration (HCFA) imposed a moratorium on Medicare reimbursement for the new procedure until a properly designed, randomized trial could be performed. Thus, through the collaboration ofhcf A and the NHLBI, the multicenter National Emphysema Treatment Trial (NETT) was conceived. As of the writing of this book, the trial is underway, with results still several years away. It is the hope of the physicians and patients involved in this trial that valuable information is gained, with the ultimate goal of determining if (and for whom) the operation is in fact beneficial. vii

6 Vlll Preface Lung Volume Reduction Surgery was conceived in response to the enthusiasm, controversy, confusion, and disappointment that, in the experience of the editors, have variously (and often simultaneously) characterized the attitudes of clinicians and scientists toward this novel and potentially revolutionary operation. In the chapters that follow, we attempt to elucidate the current state of knowledge surrounding L VRS, in order to define the clinical and scientific landscape for those interested in this field. In Part One, experts in clinical medicine and the basic sciences review the diagnosis, pathophysiology, and medical management of emphysema, in order to ground the reader in the disciplines that form the basis of our current knowledge. In Part Two, the technical aspects and clinical results of L VRS are reviewed, with additional emphasis on organizational issues important for those involved or planning to be involved in L VRS programs. This book is intended for readers of diverse backgrounds, including surgeons, pulmonologists, primary care physicians, physiologists, radiologists, basic scientists, physical and occupational therapists, and nurses. It is the hope of the editors that the information contained in this book will be of help to these professionals and to all those who share the mission of providing the best possible care to patients with emphysema. The question of whether L VRS will have a future role in the treatment of emphysema is currently unanswered. A clear and complete answer to this question will likely require years of clinical experience, careful analysis of properly designed randomized trials, and perhaps most importantly, a redefinition by society of the importance of palliation in the treatment of incurable diseases. Despite the controversy that is certain to surround L VRS in the coming years, the debate that has been generated has already had positive effects. The enthusiasm generated by this novel operation has brought a fresh perspective and a new generation of researchers into the fields of pulmonary physiology and end-stage lung disease. In this environment, a unique opportunity exists for both clinicians and researchers to uncover the physiologic and molecular determinants of this devastating disease. Although LVRS may one day be shown to improve (and perhaps prolong) the lives of patients suffering from emphysema, it is far more exciting to think that the research initiated in these early L VRS years might one day lead to an actual cure of the disease. Michael Argenziano, MD Mark E. Ginsburg, MD

7 CONTENTS Dedications... v Preface... vii Contributors... xi Part One: Diagnosis, Pathophysiology, and Medical Management of Emphysema The Pathogenesis and Pathophysiology of Emphysema... 3 Neil W. Schluger and Jeanine D'Armiento 2. Cardiopulmonary Exercise Testing in the Evaluation of the Patient with Emphysema David Balfe and Zab Mohsenifar 3. Cardiovascular Effects of Emphysema Steven M. Scharf 4. Radiologic Assessment of Emphysema in L VRS Candidates John H. M. Austin, Gregory D. N. Pearson, Maria C. Shiau, and Yahya M. Berkmen 5. Medical Management of Emphysema and Chronic Obstructive Pulmonary Disease Chun K. Yip 6. Pulmonary Rehabilitation in Severe Emphysema Matthew N. Bartels Part Two: Lung Volume Reduction Surgery for Emphysema The History of Surgery for Emphysema Joseph J. DeRose, Jr. and Kenneth M. Steinglass 8. Lung Volume Reduction Surgery: Open Technique Antonio L. Visbal, Claude Deschamps, and James P. Utz 9. Lung Volume Reduction Surgery: Video-Assisted Thoracoscopic Approaches Joshua R. Sonett and Mark J. Krasna 10. Anesthetic Management of the Patient Undergoing Lung Volume Reduction Surgery Ellise S. Delphin 11. Perioperative and Nursing Care of the LVRS Patient Patricia A. Jellen and Frances Brogan 12. Selection of Candidates for Lung Volume Reduction Surgery Byron Thomashow ix

8 x Contents 13. Clinical Results and Clinical Trials in Lung Volume Reduction Surgery Charles W. Hoopes and Mark D. Iannettoni 14. Effect of Lung Volume Reduction Surgery on Survival in Patients with Advanced Emphysema Michael Argenziano, Lyall A. Gorenstein, and Mark E. Ginsburg 15. Management of the Patient with Lung Cancer and Severe Emphysema Joseph J. DeRose, Jr., Michael Argenziano, and Mark E. Ginsburg 16. Lung Transplantation and L VRS in the Treatment of Advanced Emphysema Larry L. Schulman Index

9 CONTRIBUTORS MICHAEL ARGENZIANO, MD Division of Cardiothoracic Surgery, New York Presbyterian Hospital-Columbia Presbyterian Center, New York, NY JOHN H.M. AUSTIN, MD Department of Radiology, New York Presbyterian Hospital, New York, NY DAVID BALFE, MBBCH, FCP, SA Division of Pulmonary/Critical Care Medicine, Cedars Sinai Medical Center, Los Angeles, CA MATTHEW N. BARTELS, MD, MPH Division of Rehabilitation Medicine, Columbia University College of Physicians and Surgeons, New York, NY YAHYA M. BERKMEN, MD Department of Radiology, New York Presbyterian Hospital, New York, NY FRANCES BROGAN, MSN, RN Lung Volume Reduction Program, New York Presbyterian Hospital, New York, NY JEANINE D' ARMIENTO, MD Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY JOSEPH J. DEROSE, JR., MD Division of Cardiothoracic Surgery, New York Presbyterian Hospital-Columbia Presbyterian Center, New York, NY ELLISE S. DELPHIN, MD, MPH Department of Anesthesiology, New York University School of Medicine, New York, NY CLAUDE DESCHAMPS, MD Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN MARK E. GINSBURG, MD Division of Cardiothoracic Surgery, New York Presbyterian Hospital-Columbia Presbyterian Center, New York, NY LYALL A. GOREN STEIN, MD Division ofcardiothoracic Surgery, New York Presbyterian Hospital-Columbia Presbyterian Center, New York, NY CHARLES W. HOOPES, MD Section of General Thoracic Surgery, University of Michigan Medical Center, Ann Arbor, MI MARK D. IANNETTONI, MD Section of General Thoracic Surgery, University of Michigan Medical Center, Ann Arbor, MI PATRICIA A. JELLEN, MD Lung Volume Reduction Program, New York Presbyterian Hospital, New York, NY MARK J. KRASNA, MD Division of Thoracic Surgery, University of Maryland, Baltimore, MD ZAB MOHSENIFAR, MD, FCCP Division of Pulmonary/Critical Care Medicine, Cedars Sinai Medical Center, Los Angeles, CA GREGORY D. N. PEARSON, MD Department of Radiology, New York Presbyterian Hospital, New York, NY STEVEN M. SCHARF, MD, PhD Division of Pulmonary and Critical Care Medicine, Long Island Jewish Medical Center, New Hyde Park, NY Xl

10 xu Contributors NEIL W. SCHLUGER, MD Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY LARRY L. SCHULMAN, MD Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons, New York, NY MARIA C. SHIAU, MD Department of Radiology, New York Presbyterian Hospital, New York, NY JOSHUA R. SONETI, MD Division of Thoracic Surgery, University of Maryland, Baltimore, MD KENNETH M. STEINGLASS, MD Division of Cardiothoracic Surgery, New York Presbyterian Hospital-Columbia Presbyterian Center, New York, NY BYRON THOMASHOW, MD Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons, New York, NY JAMES P. UTZ, MD Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN ANTONIO L. VISBAL, MD Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN CHUN K. YIP, MD Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY