Related Experiment Video
Updated: Jun 18, 2026
Non-Intubated Video-Assisted Thoracoscopic Surgery
Published on: May 26, 2023
Age-related differences in pleural adhesion and perioperative outcomes in uniportal video-assisted thoracoscopic
1Department of Thoracic & Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Background:
Advanced age is often associated with increased technical difficulty during lung resection; however, the mechanisms underlying age-related operative burden during segmentectomy remain unclear. This study aimed to evaluate age-related differences in pleural adhesion, operative complexity, and perioperative outcomes in patients undergoing uniportal video-assisted thoracoscopic surgery (VATS) segmentectomy for lung cancer.
Methods:
Consecutive patients who underwent uniportal VATS segmentectomy were retrospectively reviewed. Patients were stratified into two groups according to age (<70 vs. ≥70 years). Baseline characteristics, radiologic and operative findings, pleural adhesion status, and postoperative outcomes were compared between the groups. Pleural adhesion was categorized as absent, partial, or whole. Continuous variables were compared using the Student's t-test or Wilcoxon rank-sum test, as appropriate. Multivariable logistic regression was performed to identify independent predictors of pleural adhesion.
Results:
A total of 814 patients were included, of whom 683 were aged <70 years and 131 were aged ≥70 years. Pleural adhesion was significantly more frequent in patients aged ≥70 years than in those aged <70 years (26.7% vs. 8.8%, P<0.001), and whole pleural adhesion was also more common in the elderly group (5.3% vs. 1.8%, P=0.02). In multivariable analysis, age remained independently associated with pleural adhesion (adjusted OR 1.11 per year increase, 95% CI: 1.08-1.14, P<0.001). Patients aged ≥70 years demonstrated greater operative burden, with longer operative time (median 91 vs. 89 minutes, P=0.002) and longer postoperative chest tube duration {median [interquartile range]: 1 [1-3] vs. 1 [1-1] days, P<0.001}. The incidence of postoperative complications was significantly higher in the elderly group (12.2% vs. 3.8%, P<0.001), including a higher rate of prolonged air leak. Surgical margin distance was comparable between the two groups.
Conclusions:
Elderly patients undergoing uniportal VATS segmentectomy exhibited a significantly higher incidence of pleural adhesion and were associated with longer operative time and postoperative drainage, as well as higher complication rates. Nevertheless, acceptable postoperative outcomes can be achieved, supporting the feasibility of segmentectomy in carefully selected elderly patients.
