NETT
Trial question
What is the role of lung volume-reduction surgery in patients with severe emphysema?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
39.0% female
61.0% male
N = 1218
1218 patients (472 female, 746 male).
Inclusion criteria: patients with severe emphysema who underwent pulmonary rehabilitation.
Key exclusion criteria: high risk for perioperative morbidity or mortality; disease unsuitable for lung volume reduction surgery; and medical conditions precluding the completion of trial.
Interventions
N=608 lung volume-reduction surgery (goal to resect 20-35% of each lung, targeting the most diseased portion plus medical treatment).
N=610 medical therapy (continued medical treatment without surgery).
Primary outcome
Improvement in exercise capacity at 24 months
15%
3%
15.0 %
11.3 %
7.5 %
3.8 %
0.0 %
Lung volume-reduction
surgery
Medical
therapy
Significant
increase ▲
NNT = 8
Significantly greater improvement in exercise capacity at 24 months (15% vs. 3%; OR 6.27, 95% CI 2.55 to 9.99).
Secondary outcomes
Significantly greater improvement in health-related QoL (33% vs. 9%; OR 4.9, 95% CI 1.99 to 7.81).
Significant increase in death at day 90 (7.9% vs. 1.3%; AD 6.6%, 95% CI 2.68 to 10.52).
No significant difference in total deaths (25.8% vs. 26.2%; AD -0.4%, 95% CI -6.16 to 5.36).
Conclusion
In patients with severe emphysema who underwent pulmonary rehabilitation, lung volume-reduction surgery was superior to medical therapy with respect to improvement in exercise capacity at 24 months.
Reference
Fishman A, Martinez F, Naunheim K et al. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med. 2003 May 22;348(21):2059-73.
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