Pectus excavatum in adults over 40: a retrospective review of surgical experience

Pectus excavatum is the most common congenital anterior chest wall deformity, typically corrected during adolescence. However, an increasing number of adult patients seek surgical repair due to persistent symptoms or cosmetic concerns. Surgical correction in adults poses unique challenges, and data on outcomes in older patients remain limited. This study aimed to evaluate the clinical characteristics, surgical techniques, and postoperative outcomes of pectus excavatum repair in patients aged 40 years and older. We retrospectively analyzed adult patients aged ≥ 40 who underwent surgical repair for pectus excavatum at our center between 2012 and 2025. Clinical indications, operative details, and postoperative outcomes were evaluated. Patients younger than 40 years were used as a comparative cohort. Postoperative complications were categorized as minor or major according to the Clavien-Dindo classification system. A total of 16 patients (mean age: 46.9 years) underwent minimally invasive repair of pectus excavatum (MIRPE). A cross-bar configuration was applied in 56.3% of patients, and two or more bars were required in 87.5%. The most common surgical indication was symptomatic presentation (50%). Postoperative complications occurred in 5 patients (31.3%), including 3 major and 2 minor events. Compared with younger patients (n = 1180), the older cohort demonstrated a higher complication rate, although this difference did not reach statistical significance. Surgical repair of pectus excavatum in patients over the age of 40 is feasible and safe when appropriate techniques are applied. Despite increased anatomical stiffness necessitating complex configurations, acceptable clinical outcomes can be achieved. Age alone should not be considered a contraindication for pectus repair in well-selected adult patients.