Objectives <p>The presence of pleural adhesions during lung cancer surgery can obstruct the surgical field and inhibit maneuverability, thereby potentially complicating the procedure. The current study examined the potential predictive factors of pleural adhesions using standard preoperative examinations for lung cancer surgery without additional assessments.</p> Methods <p>This study included 542 patients with primary lung cancer who underwent chest computed tomography scan and positron emission tomography before undergoing surgery between January 2021 and September 2024. To assess differences in lung expansion between inspiration and natural breathing, the ratio of lung computed tomography scan measurements obtained during maximal inspiration-to-lung positron emission tomography measurements during spontaneous breathing was calculated. The ratios were compared between patients with pleural adhesions and those without.</p> Results <p>In total, 56 patients were classified under the adhesion group and 486 under the non-adhesion group. If the ratio of the distance from the lung base to the interlobar fissure, measured on coronal computed tomography scan and positron emission tomography, was ≤ 1.390, and the angle of the lung base, measured on sagittal computed tomography scan, was ≥ 40°, the incidence of pleural adhesions was significantly higher (24.0% vs. 4.7%; <i>p</i> &lt; 0.01).</p> Conclusion <p>Standard preoperative examinations could be effective in predicting pleural adhesion.</p>