TY - JOUR T1 - Lung volume reduction surgery: what can we learn from the National Emphysema Treatment Trial? JF - European Respiratory Journal JO - Eur Respir J SP - 571 LP - 573 DO - 10.1183/09031936.03.00077503 VL - 22 IS - 4 AU - E.W. Russi AU - K.E. Bloch AU - W. Weder Y1 - 2003/10/01 UR - http://erj.ersjournals.com/content/22/4/571.abstract N2 - Lung volume reduction surgery (LVRS), originally proposed >4 decades ago by Brantigan et al. 1, was reintroduced by Cooper et al. 2. This pioneer work provided tremendous incentives not only for other research groups worldwide to corroborate the efficacy of LVRS, as well as to uncover criteria for patient selection and predictors of outcome, but was also a unique opportunity to comprehensively study the physiology of end-stage emphysema. Clinicians with the opportunity to observe the remarkable improvements in shortness of breath and lung function after surgery in appropriately selected patients did not need not to be persuaded that such changes are real and cannot be attributed to a placebo effect. Several large case series from centres with considerable experience have demonstrated a low operative mortality (<5%) and significant improvements in symptoms, pulmonary function, and exercise capacity in the short and intermediate term after LVRS 3–7. Three prospective randomised studies confirmed functional improvements in the operated group, whereas this was not observed in the conservativelytreated control arm 8–10. Nonetheless, controversy remained with respect to potential benefits and risk of the procedure 11, 12. This prompted the editor of a prestigious journal to claim that only adequately controlled clinical trials would prove that LVRS eventually works 13, 14. Initial enthusiasm for LVRS was soon dampened due to reports on surgical mortality rates of up to 17% 9. A review of Medicare claims showed a 6‐month mortality rate of 16.9% 15. Since many surgeons started to perform LVRS in desperate chronic obstructive pulmonary disease (COPD) patients without including them at least in prospective case series to ascertain a certain quality control, it was understandable that some health insurance companies stopped paying for LVRS in the USA. Eventually, the National … ER -