The negative impact of pleural adhesion on pulmonary function: a retrospective study

Pleural adhesion refers to fibrotic or proliferative changes resulting in lesions between the visceral and parietal pleura, which can be caused by various factors. It is common and often asymptomatic, but may lead to impaired pulmonary function, especially in cases of severe or extensive adhesion. Existing studies mainly focus on pleural thickening caused by conditions such as tuberculous pleuritis. However, research on mild or localized pleural adhesions and their impact on preoperative pulmonary function remains limited. Therefore, this study aims to evaluate the specific effects of the site and extent of pleural adhesions on pulmonary function. This will provide evidence to guide future interventions aimed at reducing postoperative adhesions and preserving lung function in patients who may undergo repeat thoracic procedures.

This study included 199 pairs of patients who underwent right-sided thoracoscopic lung tumor resection, and their demographic and clinical characteristics were collected. To reduce confounding, propensity score matching was performed. Subsequently, factorial ANOVA and repeated measures ANOVA were conducted, followed by Tukey's HSD test and Bonferroni post-hoc corrections.

After propensity score matching, there were no significant differences in baseline characteristics, such as gender, age, and smoking history, between the patients with pleural adhesions and patients without pleural adhesions (standardized mean difference < 0.02). The results showed that the site of pleural adhesions significantly affected pulmonary function (P < 0.001). Specifically, adhesion to the chest wall had a more pronounced impact on FEV1, RV, and TLC than adhesions on the apical, diaphragmatic, and mediastinal surfaces (P < 0.001). Furthermore, analysis revealed a direct correlation suggesting that increased extent of pleural adhesions was associated with greater pulmonary function impairment. Patients with pleural adhesions exceeding 60% of the pleural surface exhibited significant reductions in FEV1, RV, and TLC (P < 0.001). These patients showed significantly greater pulmonary function impairment than those with adhesions in the 30%-59% (P < 0.001) and 15%-29% (P < 0.001) ranges.

Both the site and extent of pleural adhesion are associated with a significant negative impact on pulmonary function, with the most pronounced impairment occurring when pleural adhesions are located on the chest wall and affect more than 60% of its surface area. These findings highlight the need for intraoperative awareness and potential preventive strategies in patients with extensive adhesions.