Li SJ, et al. - In this single-center retrospective analysis, researchers looked at the impacts of pleural adhesions on perioperative outcomes in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for non-small-cell lung cancer (NSCLC). It was shown that conversion to thoracotomy and postoperative surgical complications could be predicted by the presence of pleural adhesions in this patient population. This inquiry calls for an internationally accepted grading system for the presence of pleural adhesions to stratify the surgical risk.

• Researchers conducted a single-center retrospective analysis on the prospectively-maintained dataset at their unit from February 2014 to November 2015.
• They categorized patients into 2 groups (Group A: presence of pleural adhesions; Group B: absence of pleural adhesions) according to the grading system of pleural adhesions when entering the chest cavity.
• They initially estimated demographic differences in perioperative outcomes between these 2 groups.
• Thereafter, they performed a multivariate logistic-regression analysis to confirm the predictive value of the presence of pleural adhesions.

• This study included a total of 593 NSCLC patients undergoing VATS lobectomy.
• Data showed that the conversion and postoperative morbidity rates were 3.2% and 29.2%, respectively.
• Researchers found that there were 154 patients with pleural adhesions (Group A) and 439 patients without pleural adhesions (Group B).
• They also noted that Group A patients had significantly higher rates of conversion to thoracotomy (9.1% vs 1.1%; P<0.001) and surgical complications (24.0% vs 14.4%; P=0.006) compared with those of Group B patients.
• In terms of overall morbidity and cardiopulmonary complication rates, both these groups did not differ significantly.
• Findings demonstrated that the presence of pleural adhesions was also significantly associated with the prolonged length of chest tube drainage (logrank P<0.001) and length of stay (log-rank P=0.032).
• Finally, multivariate logistic-regression analyses revealed that the presence of pleural adhesions independently conferred risk for conversion to thoracotomy [odds ratio (OR) =5.49; P=0.003] and surgical complications (OR =1.94; P=0.033).