Impacts of pleural adhesions on lobectomies for malignant lung tumors

Pleural adhesions are sometimes troublesome in lung lobectomies, and how they affect such surgeries depends on the degree of the adhesion. Herein, pleural adhesions were categorized according to density, tenacity, and coverage, and the impact of each category on lung lobectomy was investigated.

The cases of 510 patients who consecutively underwent lobectomies were retrospectively reviewed. Pleural adhesions were classified into two classes (non-dense and dense) in the category of "Density," 3 classes (loose, firm, and very-strong) in that of "Tenacity," and 3 classes (1-10%, 10-50%, 50-100%) in that of "Coverage." The perioperative findings for each class were compared with those of patients without pleural adhesions.

The 50-100% group in the Coverage category was the most affected by pleural adhesions, and the very-strong group in the Tenacity category was the next. In these 2 groups, when compared with the no-adhesion group, significant differences were found in operative time (336, 326 vs 231 min), amount of bleeding (187.5, 80 vs 20 g), and frequency of prolonged air leakage (20%, 22% vs 3%), respectively. The dense group, firm group, and 10-50% group also significantly affected the perioperative course. As for postoperative complications, prolonged air leakage was the most problematic.

The impact of pleural adhesions on lobectomy would be greater if the pleural adhesion is dense, firm, or very-strong and has a coverage of 10% or more. Careful and patient pleural dissection is required, even if this entails a longer operative time, to minimize postoperative complications.