Head-to-head: lung volume reduction surgery vs endobronchial valves 

Lung volume reduction surgery (LVRS) was not significantly superior to bronchoscopic lung volume reduction (BLVR) with valve placement in patients with emphysema who were eligible for both treatment options. These important findings to guide treatment decisions are currently being evaluated in a larger trial.

Although LVRS and endobronchial valves (EBVs) have both demonstrated to improve lung function, exercises capacity, and quality-of-life for patients with emphysema, no existing clinical trials have directly compared LVRS with the use of EBVs [1,2]. The randomised, single-blind CELEB trial (ISRCTN19684749) assessed whether LVRS was superior to BLVR in patients with emphysema who were suitable for both procedures (n=88) [3]. The primary endpoint was the Body-mass index, airflow Obstruction, Dyspnea, and Exercise index (i-BODE) score at 12 months, a measure that includes forced expiratory volume in 1 second (FEV₁) % predicted, exercise capacity, dyspnoea, and BMI. Ms Sara Buttery (Royal Brompton and Harefield NHS Foundation Trust, UK) presented the results.

The improvements on the i-BODE score at 12 months were comparable for LVRS and BLVR (-1.10 vs -0.82; P=0.54; see Figure). Analysis of the single components of the i-BODE score did not reveal a significant advantage of 1 treatment over the other. Moreover, the residual volume % (RV%) predicted was similar in the LVRS arm and BLVR arm (-36.1% vs -30.1%; P=0.81). Finally, the safety of the procedures appeared to be similar, with 1 death at 12 months in each arm of the study.

Figure: Primary outcome of the CELEB trial [3]



i-BODE, Body-mass index, airflow Obstruction, Dyspnea, and Exercise index; LVRS, lung volume reduction surgery; BLVR, bronchoscopic lung volume reduction.

Ms Buttery concluded that LVRS was not substantially superior to BLVR in the current trial. A larger trial (NCT04537182) is underway to confirm these findings and to evaluate the cost-benefit of the 2 treatments.

1. Criner G, et al. Am J Respir Crit Care Med. 2011;184(7).
2. Kemp SV, et al. Am J Respir Crit Care Med. 2017;196(12).
3. Buttery S, et al. Comparative Effect of Lung volume reduction surgery for Emphysema and Bronchoscopic lung volume reduction with valve placement: the CELEB trial. ALERT 4, RCT4448, ERS International Congress 2022, Barcelona, Spain, 4–6 September.

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Posted on 30 October, 202227 March, 2024