Postoperative early laboratory changes and follow-up process of patients underwent hyperthermic intrathoracic chemotherapy

Our plain-English summary of Postoperative early laboratory changes and follow-up process of patients underwent hyperthermic intrathoracic chemotherapy, by S. Aydin, S.K. Aydin, H. Yavuz, et al (BMC Surgery, 2024).

The study

• Authors: S. Aydin, S.K. Aydin, H. Yavuz, A.G. Ergonul, T.I. Akcam, K. Turhan, A. Cakan, U. Cagirici
• Journal: BMC Surgery
• Published: 2024;24(1):267
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: The aim of combining hyperthermic intrathoracic chemotherapy (HITHOC) with surgery is to achieve local control in patients with pleural malignancies. Liver and kidney dysfunction resulting from this procedure have been reported in the literature. The objective of the study is to examine whether the laboratory abnormalities observed during the initial period persist until day 30.

Methods: The study conducted a retrospective analysis of the blood glucose levels, renal function markers, and hepatic function markers of 30 patients who underwent pleurectomy-decortication and HITHOC for pleural mesothelioma from January 2010 to April 2022. The measurements were taken in the postoperative period on the first four and 30th days. The study analyzed the initial and final laboratory results caused by the procedure.

Results: Out of the total of 30 patients, 29, 28, 14, and 12 patients had elevated glucose levels on the first four days after the surgery, respectively. There was no association between glucose abnormalities and preoperative-postoperative diabetes mellitus. A minority of patients experienced atypical alterations in kidney and liver functions during the initial postoperative period. There was no apparent relationship between the renal and hepatic functions in the early and late periods after the surgery.

Conclusion: Although there were fluctuations in glucose levels and renal and hepatic functions in the early period after surgery, there were no persistent alterations in these parameters by day 30. Elevated glucose levels during the early period were not associated with the development of newly diagnosed diabetes mellitus after surgery. The findings of our study provide evidence that HITHOC is a favorable and well-tolerated treatment option for mesothelioma.

© 2024. The Author(s).

In plain English

This retrospective study reviewed records of 30 patients with malignant pleural mesothelioma treated in Izmir, Turkey, from January 2010 to April 2022. Each had pleurectomy-decortication surgery with hyperthermic intrathoracic chemotherapy (HITHOC), in which a heated cisplatin solution was circulated inside the chest for 60 minutes. The article did not examine asbestos exposure. Blood glucose, kidney markers (urea, creatinine) and liver markers (AST, ALT) were measured the day before surgery and on days 0 to 3. The kidney and liver markers were recorded again on day 30, and patients were then grouped by diabetes status. All patients had normal glucose before surgery. High glucose was found in 29 patients on day 0, 28 on day 1, 14 on day 2 and 12 on day 3. Four patients were newly diagnosed with diabetes by day 30, but early high glucose was not a statistically significant predictor of this. No patient needed dialysis in the first four days. On day 30, creatinine and AST were each normal in 29 of 30 patients. The authors concluded that HITHOC was well tolerated and that the glucose findings need further investigation. They named the small sample as the main limitation.

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 analysis of clinical records (single clinic)
• Who was studied: 30 patients with malignant pleural mesothelioma (stage I to III) who had pleurectomy-decortication and HITHOC at the authors' clinic in Izmir, Turkey, January 2010 to April 2022. 19 were male (63.3%) and the mean age was 59.97 years (range 44 to 75). 26 had epithelial and 4 had biphasic mesothelioma. Patients were excluded for several reasons: abnormal tests the day before surgery, incomplete early measurements, being unable to finish HITHOC, anatomical resection, or starting adjuvant treatment within one month.
• Exposure: Not an asbestos exposure study. The exposure examined was HITHOC: saline containing cisplatin at 100 mg/m2, the same dose for all patients. It was heated to 43 degrees C and circulated in the chest for 60 minutes after pleurectomy-decortication through thoracotomy. Patients received saline hydration before and after surgery.
• Main results:
  • All patients had normal blood glucose before surgery. After surgery, high glucose was found in 29 of 30 patients on day 0, 28 on day 1, 14 on day 2 and 12 on day 3.
  • Three patients had diabetes before surgery. By day 30, four patients were newly diagnosed with diabetes and 23 had never been diagnosed. High glucose on days 0 to 3 was not a statistically significant predictor of new diabetes (p 0.854, 0.722, 0.536 and 0.523 in the text).
  • During the first 4 days, 26 patients (86.7%) had normal urea and 28 (93.3%) had normal creatinine throughout. No patient with high urea or creatinine needed dialysis in that period.
  • On day 30, urea was normal in 26 patients (86.7%) and creatinine in 29 (96.7%). Early and day-30 abnormalities in urea and creatinine were not significantly correlated (p 0.071 and 0.964).
  • During the first 4 days, 18 patients (60%) had normal AST and 26 (86.7%) had normal ALT.
  • On day 30, AST was normal in 29 patients (96.7%) and ALT in 27 (90%). Early high AST and ALT were not significantly correlated with liver abnormalities on day 30 (p 0.953 and 0.774).
  • Not counting high glucose, 27 patients (90%) had at least one complication. The mean hospital stay was 8.40 days (range 4 to 18).
  • The authors called the high early glucose levels in most patients and the four new diabetes cases a crucial finding, although the link with diabetes was not statistically shown.
• The authors' conclusion: The authors concluded that early biochemical changes occurred but did not persist to day 30, and that HITHOC was a favorable and well-tolerated treatment option for mesothelioma. They added that the early high glucose levels and four new diabetes cases require further investigation.
• Limitations the authors state:
  • The authors stated that the main limitation was the small study population.
  • Significant data loss led to exclusions, leaving only 30 patients. The loss came from unrecorded lab measurements and from patients starting cancer treatment within the first month.
  • Complications were not classified as caused by the surgery or by HITHOC alone.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Intrathoracic, Chemotherapy, Pleurectomy/Decortication (P/D), Pleural Mesothelioma, Mesothelioma.

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• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin in pediatric patients with peritoneal mesothelioma: a single institution experience and long term follow up — P. Malekzadeh, M. Good, et al. (2021)
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