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NewYork-Presbyterian Hospital/Columbia has begun offering lung volume reduction surgery (LVRS) for select individuals with emphysema; the first patient underwent surgery on Wednesday, February 4, 2004. NewYork-Presbyterian/Columbia is the only New York City-area hospital and one of only 17 centers nationwide to be selected by the Centers for Medicare Medicaid Services (CMS) to perform the procedure after having participated in the National Emphysema Treatment Trial (NETT). NETT demonstrated that the procedure improves the quality of life for certain emphysema patients. As part of the ruling, Medicare will reimburse the procedure.

NewYork-Presbyterian/Columbia will follow the Medicare guidelines, which limit the procedure to those who have severe emphysema in the upper lobes of their lungs, and those who have severe disease elsewhere in the lungs and a poor ability to exercise. Medicare also requires that patients be further screened through testing and undergo extensive exercise and education programs to improve lung function both before and after surgery. LVRS involves cutting away diseased parts of the lungs to help the remaining healthy tissue better function.

LVRS represents the first major treatment advance for emphysema patients in almost 25 years and stands to benefit as many as 10,000 Americans, says Dr. Byron Thomashow, Medical Director of the Jo-Ann LeBuhn Center for Chest Disease and Respiratory Failure at NewYork-Presbyterian Hospital/Columbia; clinical professor of medicine at Columbia University College of Physicians Surgeons; and co-principal investigator for the NETT study.

Emphysema is a progressive, chronic, and disabling lung condition that affects primarily individuals over age 50 who are current or former cigarette smokers, says Dr. Mark Ginsburg, Surgical Director for the Jo-Ann LeBuhn Center for Chest Disease and Respiratory Failure; assistant clinical professor of surgery at Columbia University College of Physicians Surgeons; and co-principal investigator for the NETT study. With emphysema, breathing becomes difficult as the fine architecture of the lung is destroyed, leading to large holes in the lung, obstructed airways, trapping of air, and difficulty exchanging oxygen because of reduced elasticity of the lungs.

In LVRS, 25 to 30 percent of the most damaged regions of each lung are surgically removed. Scientists believe that by surgically removing functionally useless tissue, air will move in and out of the remaining lung more readily, thereby easing symptoms associated with advanced emphysema and improving overall lung function. LVRS was widely performed from 1993 until 1995, at which time Medicare halted coverage of the procedure, citing concerns over risk for morbidity; many other insurance carriers followed suit. The operation costs about $60,000.

It is estimated that emphysema costs more than $2.5 billion in annual health care expenses and causes or contributes to 100,000 deaths in the U.S. each year.