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

Abstract

BackgroundPersistent 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 MethodsIn 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.ResultsA 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.InterpretationIntraoperative 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.

Contemporary issues in the surgical management of pleural mesothelioma

“…Most common surgical complication after PD, prolonged air leak (10%–57%), is related to lung parenchyma injury during visceral pleurectomy 20,21,23,25 . Persisted air leak can lead to prolonged hospital stay and chest tube use, and is associated with increased risk of empyema and intensive care unit readmission 35 . Prolonged air leak is usually managed conservatively with maintenance of chest tube until full lung expansion or resolution of the air leak.…”

“…Prolonged air leak is usually managed conservatively with maintenance of chest tube until full lung expansion or resolution of the air leak. If substantial lung parenchymal injury is noted, some centers install absorbable lung sealant or use intraoperative hypertonic glucose solution during surgery, but more prospective data is needed before larger adaptation of these techniques 23,35 . Other common complications related to PD are deep vein thrombosis (21%–23%), atrial fibrillation (7%–28%), pneumonia (7%–28%), chyle leak (5%–13%), and empyema (1%–8%) 20,21,23,25 …”

“…If substantial lung parenchymal injury is noted, some centers install absorbable lung sealant or use intraoperative hypertonic glucose solution during surgery, but more prospective data is needed before larger adaptation of these techniques. 23,35 Other common complications related to PD are deep vein thrombosis (21%-23%), atrial fibrillation (7%-28%), pneumonia (7%-28%), chyle leak (5%-13%), and empyema (1%-8%). 20,21,23,25 The assessment of QoL has been infrequently reported in surgical studies.…”