Out of the sample population, 63.3% were male, which amounts to nineteen individuals. The mean age was 59.97 ± 8.87 (44–75) years. When analyzing the data by geographic regions, it was found that nine patients (30%) were admitted from the Aegean region, followed by six patients (20%) from the Central Anatolia region, and five patients (16.7%) from the Southeastern Anatolia region. Out of the total number of patients, ten individuals (33.3%) had at least one additional medical condition. Specifically, six patients (20%) had hypertension, three patients (10%) had diabetes mellitus, two patients (6.7%) had hyperthyroidism, and one patient (3.3%) had rheumatoid arthritis.
Mean values of glucose, urea, creatinine, AST and ALT measured on pre-op, post-op 0,1,2 and post-op 30th days
A total of 30 patients underwent PD and HITHOC for MPM. Sixteen (53.3%) of the patients were operated from the right hemithorax. In postoperative period, at least one hyperglycemic value was seen in 29 patients. Hyperglycemia wasn’t considered as a complication. Therefore, there were 27 patients (90%) with at least one complication. Patient characteristics, early and late complications are presented in Table 1.
During the preoperative period, all patients had normal blood glucose levels. However, on postoperative day 0, 29 of them exhibited hyperglycemia. The number of patients with hyperglycemia decreased progressively, with 28 on day 1, 14 on day 2, and 12 on day 3. The glycose levels exhibited a consistent downward trend on a daily basis. Simultaneously, the average glucose levels of all patients exhibited a declining trend, as shown in the figure. The alterations in glycose patterns were documented and classified. Hence, the glucose levels demonstrated a progressive decrease over a period of time in a collective of 18 patients. The all glycose levels of 9 cases were elevated. The glucose levels of two patients exhibited fluctuation, whereas the glucose level of one patient demonstrated an increase.
The presence of DM during the preoperative period did not show any significant relationship with early postoperative glucose measurements (p-values: 0.735, 0.626, 0.464, 0.320 for glucose measurements at 0, 1, 2, and 3 days respectively) or with the patterns of glucose levels observed on a daily basis (p-value: 0.528). Three patients had preoperative DM. On the 30th day after surgery, four patients were newly diagnosed with diabetes mellitus (DM), while twenty-three patients remained without a DM diagnosis. High glycose values on day 0, 1, 2, 3 weren’t prognostic factors for the development of new DM after surgery (respectively p: 0.854, 0.722, 0.536, 0.523). There was no statistically significant correlation between the course of glucose and the development of DM (p:0.579) (Table 2).
During the initial 4 days following the surgery, 26 patients (86.7%) exhibited normal urea levels, while 28 patients (93.3%) maintained normal creatinine values throughout all measurements. There were no patients with high levels of urea or creatinine who needed dialysis within the initial four-day period. On the 30th day, urea levels of 26 patients (86.7%) and creatinine levels of 29 patients (96.7%) were within the normal range. There was no correlation observed between early and late abnormality in urea and creatinine levels (urea p-value: 0.071, creatinine p-value: 0.964). The incidence of renal failure was remarkably low.
During the initial 4 days after surgery, 18 patients (60%) had normal AST values, while 26 patients (86.7%) had normal ALT values. On day 30, AST values of 29 patients (96.7%), and ALT values of 27 patients (90%) were normal. There was no correlation between elevated levels of AST and ALT in the early period and the occurrence of liver function abnormalities on postoperative day 30 (p-values: 0.953 and 0.774, respectively). It is noteworthy that abnormal values in the early period returned to normal in the majority of patients by day 30. The figure displays the distribution of the mean values of urea, creatinine, AST, and ALT measurements based on each of the days.
Increased incidence of abnormal values in all parameters was observed among older patients and males, although no statistically significant differences were found. Mesothelioma subtype, preoperative comorbidities and stage weren’t associated with the early (including glucose) or late postoperative measurements of any parameter. The mean hospital stay was 8.40 ± 3.73 [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18] days. When factors such as age, gender, comorbidities and disease stage were investigated, no significant relationship was found between these factors and hospital stay.
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