The National Emphysema Treatment Trial (NETT)
Objectives:
To compare lung-volumereduction surgery with
medical therapy for severe emphysema, and to identify patient selection
criteria for lung volume reduction surgery.
Background:
Lung-volumereduction surgery has been proposed
as a palliative treatment for severe emphysema. Effects on mortality, the
magnitude and durability of benefits, and criteria for the selection of
patients have not been established.
Subjects:
A total of 1,218 patients with severe emphysema
underwent pulmonary rehabilitation and were randomly assigned at 17 centers to
undergo lung-volumereduction surgery (bilateral stapled wedge resection)
or to receive continued medical treatment. Patients were randomized after a
6-10 week pulmonary rehabilitation period and patients with a forced expiratory
volume in one second (FEV1) that was 20 percent or less of predicted and a
homogeneous distribution of emphysema or carbon monoxide diffusing capacity 20
percent or less of predicted were not eligible for randomization due to poor
post-surgery prognosis for death or functional improvement.
Conclusions:
Overall, lung-volumereduction surgery increases
the chance of improved exercise capacity but does not confer a survival
advantage over medical therapy. It does yield a survival advantage for patients
with both predominantly upper-lobe emphysema and low base-line exercise
capacity. Patients previously reported to be at high risk and those with
nonupper-lobe emphysema and high base-line exercise capacity are poor
candidates for lung-volumereduction surgery, because of increased
mortality and negligible functional gain. (NEJM 2003;348:2059-2073).
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Study Website |
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Study Documentation |
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Data Distribution Agreement |
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