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

IF 4.6 2区医学 Q1 RESPIRATORY SYSTEM

Lung Pub Date : 2025-01-06 DOI:10.1007/s00408-024-00777-0

Shota Yamamoto, Nobuyuki Horita, Ryosuke Imai, Takayuki Niitsu

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引用次数: 0

Abstract

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.

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手术和支气管镜下肺减容治疗严重肺气肿：系统综述和网络荟萃分析。

背景：与肺减容手术（LVRS）一样，支气管镜下肺减容是治疗终末期肺气肿的一种选择。然而，干预措施之间的比较仍然不足。方法：检索PubMed、CENTRAL、Embase和Web of Science。我们纳入了随机对照试验，其结果包括6个月内的中期死亡率、一秒钟用力呼气量（FEV1）的变化、圣乔治呼吸问卷（SGRQ）、距基线6分钟步行距离（6MWD）、与手术相关的不良事件和5年内的长期死亡率。进行贝叶斯网络元分析。确定性是由CINeMA评估的。结果：纳入25项随机对照试验，涉及4283例患者，确定了7种类型的程序和护理标准。LVRS和支气管内瓣膜（EBV）中期死亡率增高(LVRS，风险比[RR] 3.26, 95% CrI 1.98 ~ 6.21，低确定性；EBV, RR 2.06 95% CrI 1.07-4.36，中等确定性)。LVRS表现出最大的改善：FEV1 (187.2 mL, 95% CrI 166.4-209.6), 6MWD （42.2 m, 95% CrI 33.2-50.5）和SGRQ（- 13.29点，95% CrI - 27.25-0.75）的变化。在支气管镜手术中，EBV和支气管内线圈（EBC）对FEV1变化的疗效较高(EBV, 111.8 mL, 95% CrI 92.2-136.2；EBC, 74.1 mL, 95% CrI 47.6-101.7)。两组患者气胸发生率升高(EBV, RR 12.75, 95% CrI 5.52 ~ 35.48；EBC, RR 4.95, 95% CrI 1.12-40.90)。结论：LVRS疗效高，但中期死亡率增高。EBV和EBC也有效果；然而，它们增加了气胸，EBV略微增加了死亡率。为了准确评估，需要BLVR的长期生存数据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lung 医学-呼吸系统

CiteScore

9.10

自引率

10.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Lung publishes original articles, reviews and editorials on all aspects of the healthy and diseased lungs, of the airways, and of breathing. Epidemiological, clinical, pathophysiological, biochemical, and pharmacological studies fall within the scope of the journal. Case reports, short communications and technical notes can be accepted if they are of particular interest.