Reduction Surgery to Treat Emphysema
06 Mar 2005
“Damn those cigarettes,” an angry Johnny Carson repeated over and over as he slowly died from emphysema. Unfortunately, Carson should have said “damn those cigarettes” years ago. The former star of the Tonight Show could have stopped destroying his lungs. But Carson, like so many others, failed to realize that once damage has occurred nothing can restore lung tissue. However, a new surgical operation, lung volume reduction surgery (LVRS), can help to improve the quality of life for some patients suffering from emphysema.
Emphysema has always been frustrating to treat. Sir William Osler, one of North America’s most famous physicians, was once asked how he treated emphysema. He facetiously replied, “I send them to Egypt.” “For the climate?” a young doctor asked. “No,” Osler smiled. “It’s just the farthest place I can think of to send them.”
Emphysema causes the chest to become barrel-shaped. This occurs because lung tissue loses its elasticity, the ability to expand and contract, and air becomes trapped in dilated lung tissue. And over a period of years the pressure of this extra air gradually expands the chest cage.
Having poorly functioning lungs is not conducive to pleasant living. Patients find that merely going from bed to bathroom or even brushing teeth, become major respiratory efforts. Eventually, victims of smoking must be attached to an oxygen tank to survive. So anything that can improve their physical condition is a huge benefit for emphysema patients.
Dr. John Miller, head of thoracic surgery at McMaster University in Hamilton, Ontario, recently reported the results of a Canadian study at the annual meeting of thoracic surgeons in Tampa, Florida. The trial showed that by removing part of the destroyed lung tissue patients could enjoy an improved quality of life.
62 patients with emphysema were treated at several university centers in Canada. Half were treated by drugs and the others by LVRS in which the worst 30 percent of the diseased lung was removed. The result showed that those treated surgically were able to walk further than those treated with medicine during a six minute test.
But how can removing 30 percent of a diseased lung help? One would suspect that with less lung tissue present there would be even greater trouble breathing. But emphysema patients end up with so much dilated lung tissue that it pushes against the diaphragm and chest wall decreasing the efficiency of these structures. Removing a portion of the diseased lung provides space for the remaining lung to function more efficiently. Moreover, the diaphragm and chest wall are able to function better.
How good were the results? It depends on who you talk to. Dr. Miller says that his patients could walk an extra 130 feet compared to those treated medically. Other studies in the U.S show that patients who couldn’t walk 25 feet without shortness of breath were now able to walk four miles a day. And within three to six months some patients no longer required oxygen.
Critics of this procedure point out this is not minor surgery and the risk is not minimal. The mortality rate varies from 6 to 10 percent. Moreover, it requires 11 days of intensive care treatment following the operation and another month in hospital. The total cost of $133,000 is not a small item.
Johnny Carson and others will continue to pay a high price for this cigarette habit because smoking, unlike some diseases, kills slowly. During a recent trip to England I spoke with Richard Pito, Professor of Epidemiology at Oxford University. A study carried out by Pito and his colleagues showed that people who start smoking early in life decrease their longevity by 20 years. It means that rather than dying in their 70’s smokers go to the Great Beyond in their 50’s. Carson was just lucky that it didn’t kill him until 75 years of age.
There is no doubt that smoking has to be labeled as one of the greatest follies of mankind. And it goes on and on because smokers believe that heart attack, lung cancer and emphysema will affect somebody else, “not me” is their refrain. And every year Carson and millions of other people are proved wrong.
