title: 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.
  
  
  OBJECTIVE
  To evaluate the effectiveness of surgical sealants in preventing or in reducing postoperative air leaks after pulmonary resection for lung cancer.
  
  
  METHODS
  The electronic databases MEDLINE (1966 to 2004), EMBASE (1974 to 2004), Cancerlit (1993 to 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3/2004) and listed references were searched, and handsearching of conference proceedings was conducted to identify published and unpublished trials.
  
  
  METHODS
  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 included in the studies had undergone pulmonary resection for lung cancer.
  
  
  METHODS
  Three 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.
  
  
  RESULTS
  Twelve trials, with 1097 patients in total, were included. In eight trials there was a statistically significant difference between treatment and control patients in reducing postoperative air leaks. However this reduction only proved a significant reduction of hospital stay in one trial. Only in one trial reduction of time of chest drain removal and reduction of percentage of patient with persistent air leak were significantly smaller in the treatment group.
  
  
  CONCLUSIONS
  Although surgical sealants seem to reduce postoperative air leaks, length of hospitalisation is not affected and infectious complications may be increased. Therefore, systematic use of surgical sealants in clinical practice cannot be recommended at the moment. More randomised controlled clinical trials are needed.
authors: Thoracic Surgery, Hospital Mutua de Terrassa, Plaza Dr. Robert, 5, Terrassa, Catalonia, Spain, 08221. 30598msm@comb.es
authors: M
authors: M
authors: Serra-Mitjans
authors: J
authors: J
authors: Belda-Sanchis
authors: R
authors: R
authors: Rami-Porta
mesh_terms: D000388:Air; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D014014:Tissue Adhesives / Q000627:therapeutic use*
chemical_list: D014014:Tissue Adhesives