Surgical sealant for preventing air leaks after pulmonary resections in patients with lung cancer

Abstract

Background: Postoperative air leak is a frequent complication after pulmonary resection for lung cancer. It may cause serious complications, such as empyema, or prolong the need for chest tube and hospitalisation. Surgical sealants of different types have been developed to prevent or to reduce postoperative air leaks. A systematic review was therefore undertaken to evaluate the evidence on their effectiveness.

Objectives: To evaluate the effectiveness of surgical sealants in preventing or in reducing postoperative air leaks after pulmonary resection for lung cancer.

Search strategy: Electronic databases and, bibliographies were searched and, hand searching of conference proceedings was conducted to identify published and unpublished trials.

Selection criteria: Randomised controlled clinical trials were included in which standard closure techniques plus a sealant were compared with the same intervention with no use of any sealant in patients undergoing elective pulmonary resection provided that a large proportion of the patients studied had undergone pulmonary resection for lung cancer.

Data collection and analysis: Two reviewers independently selected the trials to be included in the review, assessed methodological quality of each trial and extracted data using a standardised form. Because of several limitations, narrative synthesis was used at this stage.

Main results: Two hundred and thirty-two patients from 4 trials were included. In two trials no differences were found between treatment and control patients in terms of reduction of duration of air leaks, chest tube drainage, hospitalisation or complications attributable to prolonged intercostal drainage. In the other two trials, postoperative air leaks were significantly reduced in the treatment groups, but there were no differences in hospital stay, complications, fever, intraoperative and postoperative intubation times, chest tube drainage or cost.

Reviewer's conclusions: Systematic use of surgical sealants in clinical practice cannot be recommended at the moment. More randomised controlled clinical trials are needed.