Pulmonary Emphysema Clinical Trial
Official title:
Randomized Comparison of Thoracoscopic Lung Volume Reduction Surgery Performed by Resectional Surgical Technique Under General Anesthesia or by a Non-Resectional Technique in Awake Patients Under Sole Epidural Anesthesia
Lung volume reduction surgery is effective in improving pulmonary function and quality of life in selected patients with severe emphysema although the morbidity of this surgical procedure is still considerable. Morbidity is mainly addressed to general anesthesia-related adverse effects and surgical trauma deriving from lung resection. Having developed an awake nonresectional lung volume reduction surgery technique, which is performed under sole thoracic epidural anesthesia, we have hypothesized that it could offer satisfactory clinical results and reduced morbidity rate when compared with the conventional surgical procedure.
There is increasing scientific evidence that resectional lung volume reduction (LVR) can
induce long lasting clinical improvements in selected patients with upper-lobe predominant
emphysema and that clinical benefit and survival are better than those achieved with
maximized medical treatment. The most widely employed surgical technique entails unilateral
or bilateral staple resection of the most emphysematous lung tissue performed under general
anesthesia through open or thoracoscopic approaches.
However, the type of surgical approach did not modify the considerable procedure-related
morbidity, which can be mainly addressed to general anesthesia and surgical trauma deriving
from resection of emphysematous lung tissue. Indeed, following resectional LVR expected
mortality and pulmonary morbidity are 5.5% and 30%, respectively. Time spent for
postoperative recovering is often prolonged with about 30% of patients still hospitalized or
in rehabilitation facilities at 1 month and 15% still not at home 2 months after the
operation. As a result, the cost-effectiveness of LVR continue to be questioned.
In recent years, the concept of nonresectional LVR is being investigated and new
bronchoscopic approaches have been developed in an attempt of reducing the typical
shortcomings of resectional LVR. Within the framework of the proposed nonsurgical methods
which differ somewhat in physiopathologic bases and mechanism of LVR, a common denominator
is that, so far, all needed general anesthesia.
We have developed an awake nonresectional LVR surgery technique, which respects the basic
concepts of resectional LVR but adds some theoretical advantages and is performed under sole
thoracic epidural anesthesia.
Following an initial pilot study to assess feasibility and early results, we want to analyze
in a randomized fashion the perioperative morbidity and comprehensive 2-year results of
thoracoscopic lung volume reduction surgery performed by the awake nonresectional or
nonawake resectional surgical techniques.
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Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Subject), Primary Purpose: Treatment
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