Efficacy of Intraoperative Hypertonic Glucose Solution Administration on Persistent Air Leak After Extended Pleurectomy/Decortication for Malignant Pleural Mesothelioma: A Retrospective Case-Control Study

Our plain-English summary of Efficacy of Intraoperative Hypertonic Glucose Solution Administration on Persistent Air Leak After Extended Pleurectomy/Decortication for Malignant Pleural Mesothelioma: A Retrospective Case-Control Study, by A. Testori, G. Perroni, M. Alloisio, et al (Frontiers in Oncology, 2021).

The study

• Authors: A. Testori, G. Perroni, M. Alloisio, E. Voulaz, V.M. Giudici, U. Cariboni, E. Bottoni
• Journal: Frontiers in Oncology
• Published: 2021;11:767791
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Persistent air leak is a common complication occurring from 6% to 23% of cases after extended pleurectomy/decortication for malignant pleural mesothelioma. Treatment options for this complication after major lung resection are well documented in literature; nevertheless, lines of evidence in extended pleurectomy/decortication for malignant pleural mesothelioma are absent. The aim of the study is to evaluate the efficacy of intraoperative administration of 50% hypertonic glucose solution in reducing duration of air leak following extended pleurectomy/decortication for malignant pleural mesothelioma.

Materials And Methods: In this retrospective case-control study, we analyzed our electronic health record and selected those patients with a histological diagnosis of malignant pleural mesothelioma who underwent extended pleurectomy/decortication in the period 2013-2021. From 2018, we introduced a lavage with 500 ml of glucose solution at 50% concentration into the chest cavity at the end of the surgical procedure. Patients operated before 2018 were used as the control group. Postoperative glycemia was measured, and patients were followed after hospital discharge until the air leak resolved and the chest tube was removed. Statistical analysis was performed using R software.

Results: A total of 71 patients met our criteria. Treatment and control groups were similar for age, sex, smoking status, number of comorbidities, tumor histotype, and side of disease. Use of hypertonic glucose solution resulted in shorter chest tube maintenance after hospital discharge (p = 0.0028). A statistically significant difference (p = 0.02) was also found in postoperative glycemia between the treatment (103 g/dl ± 8.9) and control group (98.8 g/dl ± 8.6). Days of hospitalization and chest tube maintenance during hospitalization did not significantly differ between the groups.

Interpretation: Intraoperative administration of 50% hypertonic glucose solution reduced the duration of air leak after hospital discharge. An increase in postoperative glycemia was found in the treatment group, but with no clinical effect. Hypertonic glucose solution is an effective and safe method to manage persistent air leak after extended pleurectomy/decortication for malignant pleural mesothelioma.

Copyright © 2021 Testori, Perroni, Alloisio, Voulaz, Giudici, Cariboni and Bottoni.

In plain English

This retrospective case-control study, from the thoracic surgery division of Humanitas Research Hospital in Milan, Italy, looked at patients with malignant pleural mesothelioma who had extended pleurectomy/decortication surgery between 2013 and 2021. Its question was persistent air leak after this surgery, not asbestos exposure. From 2018 the surgeons added a rinse of the chest cavity with 500 ml of 50% glucose solution at the end of the operation. A fibrin sealant was used in both groups. The 42 patients who received the rinse were compared with 29 operated on before 2018, and the two groups were similar in age, sex, smoking, comorbidities, tumor type and side. Among patients sent home with a chest tube (15 treated, 16 controls), the tube was removed after a mean of 4.95 days in the glucose group versus 9.14 days in controls (p = 0.0028). Hospital stay and chest tube time in hospital did not differ significantly. Blood sugar after surgery was higher in the glucose group (p = 0.02), but no patient needed treatment for it. The authors concluded the rinse was effective and safe. They named the retrospective design and small sample as the main limitations.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective case-control study (the authors' term) comparing patients who received an intraoperative glucose rinse from 2018 onward with patients operated on before 2018
• Who was studied: 71 adults with a histological diagnosis of malignant pleural mesothelioma who underwent extended pleurectomy/decortication at Humanitas Research Hospital, Milan, Italy, 2013 to 2021: 42 in the treatment group and 29 in the control group. 50 were male and 21 female, mean age 65, and 51 had neoadjuvant chemotherapy.
• Exposure: Not an asbestos exposure study (asbestos is mentioned only as background on the cause of mesothelioma). The intervention studied was 500 ml of 50% glucose solution instilled into the chest cavity and aspirated after 2 minutes at the end of surgery. Aerosolized fibrin sealant (Tisseel) was used in both groups.
• Main results:
  • Among patients discharged with a chest tube (15 in the treatment group, 16 in the control group), the tube was removed earlier in the treatment group: mean 4.95 days (standard deviation 7.79) versus 9.14 days (standard deviation 8.4), p = 0.0028
  • No significant differences between groups in days of hospitalization (mean 17 in treatment versus 14.8 in control, p = 0.07), days of chest tube during hospitalization (14.3 versus 13.1, p = 0.13), or pathological stage
  • Postoperative blood sugar was higher in the treatment group (mean 103, standard deviation 8.9) than in the control group (mean 98.8, standard deviation 8.6), p = 0.02. No patient had clinically significant symptoms and no drug treatment was needed.
• The authors' conclusion: The authors concluded that intraoperative 50% hypertonic glucose solution reduced the duration of air leak after hospital discharge and is an effective and safe way to manage persistent air leak after extended pleurectomy/decortication for malignant pleural mesothelioma. They noted that the mechanism is unknown.
• Limitations the authors state:
  • Retrospective data, which did not allow control of potential confounding factors or evaluation of parameters not routinely recorded
  • Small sample size, which prevented detection of minor differences between groups
  • The interaction between the fibrin sealant (Tisseel), used in both groups, and the glucose solution was not explored

Topics

Medical terms in this study, explained in our Lexicon: Pleurectomy/Decortication (P/D), Pleural Mesothelioma, Case-Control Study.

Related studies

• Extended Pleurectomy/Decortication for Malignant Pleural Mesothelioma: Humanitas's Experience — G. Mangiameli, E. Bottoni, et al. (2021)
• Extended pleurectomy/decortication and hyperthermic intraoperative intrapleural cisplatin perfusion for malignant pleural mesothelioma — K. Okubo, H. Ishibashi, et al. (2023)
• Intraoperative nociception and postoperative inflammation associated with the suppression of major complications due to thoracic epidural block after pleurectomy/decortication for malignant pleural mesothelioma under general anesthesia: A retrospective observational study — Y. Hamanaka, W. Ueda, et al. (2023)
• Complications and Predictive Factors for Air Leak > 10 Days with Neoadjuvant Chemotherapy Followed by Pleurectomy/Decortication for Malignant Pleural Mesothelioma — A. Nakamura, N. Kondo, et al. (2021)
• Extended Pleurectomy-Decortication-Based Treatment for Advanced Stage Epithelial Mesothelioma Yielding a Median Survival of Nearly Three Years — J.S. Friedberg, C.B. Simone, et al. (2017)
• Mesothelioma and Radical Surgery 2 (MARS 2): protocol for a multicentre randomised trial comparing (extended) pleurectomy decortication versus no (extended) pleurectomy decortication for patients with malignant pleural mesothelioma — E. Lim, L. Darlison, et al. (2020)

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