Abstract
The aim of this study was to investigate the association between image characteristics on preoperative chest CT and severe pleural adhesion during surgery in lung cancer patients. We included consecutive 124 patients who underwent lung cancer surgeries. Preoperative chest CT was retrospectively reviewed to assess pleural thickening or calcification, pulmonary calcified nodules, active pulmonary inflammation, extent of emphysema, interstitial pneumonitis, and bronchiectasis in the operated thorax. The extent of pleural thickening or calcification was visually estimated and categorized into two groups: localized and diffuse. We measured total size of pulmonary calcified nodules. The extent of emphysema, interstitial pneumonitis, and bronchiectasis was also evaluated with a visual scoring system. The occurrence of severe pleural adhesion during lung cancer surgery was retrospectively investigated from the electrical medical records. We performed logistic regression analysis to determine the association of image characteristic on chest CT with severe pleural adhesion. Localized pleural thickening was found in 8 patients (6.5%), localized pleural calcification in 8 (6.5%), pulmonary calcified nodules in 28 (22.6%), and active pulmonary inflammation in 22 (17.7%). There was no patient with diffuse pleural thickening or calcification in this study. Trivial, mild, and moderate emphysema was found in 31 (25.0%), 21 (16.9%), and 12 (9.7%) patients, respectively. Severe pleural adhesion was found in 31 (25.0%) patients. The association of localized pleural thickening or calcification on CT with severe pleural adhesion was not found (P = 0.405 and 0.107, respectively). Size of pulmonary calcified nodules and extent of emphysema were significant variables in a univariate analysis (P = 0.045 and 0.005, respectively). In a multivariate analysis, moderate emphysema was significantly associated with severe pleural adhesion (odds ratio of 11.202, P = 0.001). In conclusion, severe pleural adhesion might be found during lung cancer surgery, provided that preoperative chest CT shows substantial pulmonary calcified nodules or emphysema.
Highlights
The presence of pleural adhesions at the start of video-assisted thoracoscopic surgery (VATS) or open thoracotomy inhibits the collapse of the lung and access to the pleural space and hilum [1, 2]
There was no significant difference between no severe pleural adhesion group and severe pleural adhesion group in baseline characteristics except the results of pulmonary function test
In previous studies, including patients with benign or malignant thoracic disease, pleural adhesion during VATS or open thoracotomy was reported in a wide range; 38.5%, 60.9%, and 83.0% for any pleural adhesion [7, 14, 15] and 5.5% for severe pleural adhesion [16]
Summary
The presence of pleural adhesions at the start of video-assisted thoracoscopic surgery (VATS) or open thoracotomy inhibits the collapse of the lung and access to the pleural space and hilum [1, 2]. The prediction of pleural adhesion is necessary preoperatively to determine the appropriate surgical access and feasibility of the thoracoscopic approach. Several studies have tried to anticipate pleural adhesions with imaging modalities. We assumed that other image characteristics on CT even in the lung parenchyma, which were suggestive of old inflammation or chronic injury, could be associated with severe pleural adhesion during surgery of lung cancer. The purpose of this study was to investigate the association between image characteristics on preoperative chest CT and severe pleural adhesion in lung cancer patients who underwent VATS or open thoracotomy
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