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Background <p>Along with lung volume reduction surgery (LVRS), bronchoscopic lung volume reduction is a treatment option for end-stage emphysema. However, comparisons among interventions remain insufficient.</p> Methods <p>We searched on PubMed, CENTRAL, Embase, and Web of Science. We included randomized controlled trials with outcomes measuring mid-term mortality within 6&#xa0;months, changes in forced expiratory volume in one second (FEV<sub>1</sub>), St. George’s Respiratory Questionnaire (SGRQ), six-minute walk distance (6MWD) from baseline, adverse event related to procedures, and long-term mortality within 5&#xa0;years. Bayesian network meta-analysis was performed. The certainty was assessed by CINeMA.</p> Results <p>Twenty-five randomized controlled trials involving 4,283 patients were included, identifying seven types of procedures and standard of care. Mid-term mortality increased in LVRS and endobronchial valve (EBV) (LVRS, risk ratio [RR] 3.26, 95% CrI 1.98–6.21, low certainty; EBV, RR 2.06 95% CrI 1.07–4.36, moderate certainty). LVRS showed the largest improvements: change in FEV<sub>1</sub> (187.2&#xa0;mL, 95% CrI 166.4–209.6), 6MWD (42.2&#xa0;m, 95% CrI 33.2–50.5), and SGRQ (−&#xa0;13.29 points, 95% CrI −&#xa0;27.25–0.75). Among bronchoscopic procedures, high efficacy was noted in EBV and endobronchial coil (EBC) for FEV<sub>1</sub> changes (EBV, 111.8&#xa0;mL, 95% CrI 92.2–136.2; EBC, 74.1&#xa0;mL, 95% CrI 47.6–101.7). Pneumothorax increased in these two procedures (EBV, RR 12.75, 95% CrI 5.52–35.48; EBC, RR 4.95, 95% CrI 1.12–40.90).</p> Conclusion <p>LVRS offers high efficacies but is accompanied by increased mid-term mortality. EBV and EBC also showed effectiveness; however, they increased pneumothorax, and EBV slightly increased mortality. For accurate assessment, long-term survival data of BLVR are needed.</p>

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Surgical and Bronchoscopic Lung Volume Reduction for Severe Emphysema: A Systematic Review and Network Meta-analysis

  • 期刊论文

  • 发表日期：

    2025年1月6日

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  • Shota Yamamoto,
  • Nobuyuki Horita,
  • Ryosuke Imai,
  • Takayuki Niitsu

摘要

Background

Along with lung volume reduction surgery (LVRS), bronchoscopic lung volume reduction is a treatment option for end-stage emphysema. However, comparisons among interventions remain insufficient.

Methods

We searched on PubMed, CENTRAL, Embase, and Web of Science. We included randomized controlled trials with outcomes measuring mid-term mortality within 6 months, changes in forced expiratory volume in one second (FEV1), St. George’s Respiratory Questionnaire (SGRQ), six-minute walk distance (6MWD) from baseline, adverse event related to procedures, and long-term mortality within 5 years. Bayesian network meta-analysis was performed. The certainty was assessed by CINeMA.

Results

Twenty-five randomized controlled trials involving 4,283 patients were included, identifying seven types of procedures and standard of care. Mid-term mortality increased in LVRS and endobronchial valve (EBV) (LVRS, risk ratio [RR] 3.26, 95% CrI 1.98–6.21, low certainty; EBV, RR 2.06 95% CrI 1.07–4.36, moderate certainty). LVRS showed the largest improvements: change in FEV1 (187.2 mL, 95% CrI 166.4–209.6), 6MWD (42.2 m, 95% CrI 33.2–50.5), and SGRQ (− 13.29 points, 95% CrI − 27.25–0.75). Among bronchoscopic procedures, high efficacy was noted in EBV and endobronchial coil (EBC) for FEV1 changes (EBV, 111.8 mL, 95% CrI 92.2–136.2; EBC, 74.1 mL, 95% CrI 47.6–101.7). Pneumothorax increased in these two procedures (EBV, RR 12.75, 95% CrI 5.52–35.48; EBC, RR 4.95, 95% CrI 1.12–40.90).

Conclusion

LVRS offers high efficacies but is accompanied by increased mid-term mortality. EBV and EBC also showed effectiveness; however, they increased pneumothorax, and EBV slightly increased mortality. For accurate assessment, long-term survival data of BLVR are needed.