There is new evidence that a solution of hypertonic glucose can help correct persistent air leak – a complication that sometimes occurs after major pleural mesothelioma surgery.
Pleural mesothelioma affects the membrane that surrounds the lungs. Efforts to surgically separate a mesothelioma tumor from the surface of the lungs can damage the lungs.
When this damage causes air to seep out of the lungs into the chest cavity, it is an air leak. Some air leaks fix themselves within a few days. But when an air leak persists for more than 5 days, it can cause further complications and slow recovery after pleural mesothelioma surgery.
A team of thoracic oncologists in Milan, Italy say hypertonic glucose can help clear up persistent air leaks faster. Their hospital found that patients who had this treatment after surgery had fewer complications and spent less time with a chest tube.
Surgical Treatment of Mesothelioma
Malignant pleural mesothelioma is a rare but almost universally lethal cancer of the pleural membrane. It is usually caused by on-the-job exposure to asbestos dust. The dust fibers stay in the tissue. Over time, they can cause some cells to become malignant.
There is no cure for mesothelioma. But studies have shown that people who have pleural mesothelioma surgery tend to have the longest survival.
Extrapleural pneumonectomy (EPP) surgery includes the removal of one of the lungs along with the diseased pleural membrane. But a growing number of surgeons now favor lung-sparing pleurectomy/decortication (P/D). During P/D pleural mesothelioma surgery, surgeons remove the pleura, all or part of the diaphragm and other at-risk membranes and tissues.
Although P/D tends to cause fewer serious complications than EPP, persistent air leak (PAL) still happens in 6% to 23% of cases. Previous studies of patients with PAL suggest that it can lead to pneumonia. Some patients with PAL end up being readmitted to the intensive care unit. Other studies show an increased risk for pulmonary infection and pus in the pleural space.
Preventing PAL After Pleural Mesothelioma Surgery
The new report on preventing PAL after pleural mesothelioma surgery focused on patients at Humanitas Research Hospital in Milan. In 2018, the hospital started routinely rinsing patients’ chest cavities with a glucose solution at the end of the P/D procedure.
The goal of the new study was to compare the rate of persistent air leak among mesothelioma patients before and after the hospital started using hypertonic glucose. They matched groups of patients treated between 2013 and 2018 with a group of patients treated between 2018 and 2021. Seventy-one patients were matched by age, sex, smoking status, tumor subtype, and number of other health problems.
“Intraoperative administration of 50% hypertonic glucose solution reduced the duration of air leak after hospital discharge,” concludes lead author Alberto Testori in Frontiers in Oncology. “Hypertonic glucose solution is an effective and safe method to manage persistent air leak after extended pleurectomy/decortication for malignant pleural mesothelioma.”
Not every hospital is equipped to provide offer pleural mesothelioma surgery. If you or a loved one is coping with mesothelioma, click here to find an experienced mesothelioma doctor near you.
Testori, A, et al, “Efficacy of Intraoperative Hypertonic Glucose Solution Administration on Persistent Air Leak After Extended Pleurectomy/Decortication for Malignant Pleural Mesothelioma: A Retrospective Case-Control Study”, December 11, 2021, Frontiers in Oncology, eCollection, https://www.frontiersin.org/articles/10.3389/fonc.2021.767791/full
DeCamp MM, Blackstone EH, Naunheim KS, et al. Patient and surgical factors influencing air leak after lung volume reduction surgery: lessons learned from the National Emphysema Treatment Trial. Ann Thorac Surg 2006;82:197-206; discussion 206-7. 10.1016/j.athoracsur.2006.02.050