Study challenges surgery for lung disease.

Patients with the most severe emphysema shouldn't undergo major surgery that removes part of their damaged lungs, according to a study of more than 1,000 patients who received the operation or simply received medication for the disease.

About 2 million people have emphysema, an illness that destroys the air sacs in the lungs. The widely used surgery removes up to one-third of each damaged lung. Many surgeons say that the reduced demand on the lungs eases breathing.

However, the researchers found that among the 139 people with the most severe emphysema, surgery was of less benefit than medication. In this group, 69 people had the surgery and medication, and 70 received only medication. Within 1 month after surgery, 11 of the surgical patients died but none in the medication group did. While survivors of the surgery could walk slightly farther after 15 months than the others could, the two groups reported a similar quality of life.

There's no indication of a mortality difference among less severe cases of emphysema. The study is continuing to enroll these patients but not the sicker ones, says Gall Weinmann of the National Heart, Lung, and Blood Institute in Bethesda, Md. She and her colleagues will publish their findings so far in the Oct. 11 NEW ENGLAND JOURNAL OF MEDICINE. They released the data on the journal's Web site on Aug. 15.

"The early data ... indicate that [the surgery] may be a dangerous procedure for patients with severe emphysema," says Adam Wanner of the University of Miami School of Medicine, president of the American Thoracic Society.