[Treatment of postoperative complications after surgery for esophageal cancer and cancer of the cardioesophageal junction]. / Lechenie khirurgicheskikh oslozhnenii posle operatsii pri rake pishchevoda i kardioézophagealnogo perekhoda.

Out of 108 patients with gastric and cardiac cancer and surgical complications, 49 were treated in the routine manner and 59 operatively. The immediate results were equal in either cases: 17 (34.7 +/- 6.8%) of 49 patients and 23 (39.0 +/- 6.35%) of 59 patients died (r = 0.46). However, to compare the results of two therapeutical policies is impossible: the magnitude of pathological changes and the severity of the patients' condition is too incomparable before a decision is made which therapeutical policy is chosen. The largest number of repeated emergency operations (22 patients) was associated with impaired hermiticity of the gastrointestinal tract. The major causes of this abnormality is esophageal anastomotic suture incompetence (2.7%) and graft necrosis (1.0%). Impaired patency in various parts of the gastrointestinal tract occupies the second place in its incidence (20 patients) for which 19 repeated emergency surgical interventions were made. Postoperative bleeding requiring repeated emergency surgical intervention occurred in 0.5%; in all cases, the bleeding was intrathoracic, chylothorax was detected in 1 patient, mediastinitis without disintegrity of the digestive tube was also noted in 1 patient, pancreonecrosis was recorded in 2 cases. Due to the introduction of extensive lymph dissection into these operations in 1990, the frequency of complications increased up to 2.1%.

Non-standard combination of radiation and surgery for esophageal cancer.

Three schemes of nonstandard combination of irradiation and surgery for esophageal cancer are presented: individual approach (IA), dynamic planning (DP), and sequential scheme (SS). In IA preoperative fractionation is adjusted to the tumor size. In DP esophageal resection is performed only in nonresponders to small-fraction 40-45 Gy radiation. In SS surgery is performed after radiation with greater than 50 Gy for residual esophageal tumor or reappearance of the tumor.

[Surgical and combined treatment of esophageal cancer]. / Khirurgicheskoe i kombinirovannoe lechenie raka pishchevoda.

The authors analyse 37-year experience in the treatment of patients with esophageal carcinoma by various methods at the All-Union Cancer Research Center. The immediate and long-term results of radiotherapy and surgical and combined treatment of 1,850 patients are shown. Bearing in mind the considerable extension of the neoplastic process by the time of the operation, the authors substantiate the expediency of one-stage operations with the formation of intrapleural esophagogastric anastomoses. The mortality in the recent years after 218 Lewis' operations and 36 Herlock's operations was 9.0%. After analysing experience in combined treatment, the authors failed to reveal any particular advantages over solely surgical treatment, but in view of the lack of other alternatives for improving the results of management of esophageal carcinoma to-date, they believe it expedient to continue study and improve various combinations of preoperative radio-(chemoradio)therapy and operation in large research centres.

[Garlock's operation in cancer of the esophagus]. / Operatsiia Garloka pri rake pishchevoda.

Experience in 88 Garlock-type operations carried out in carcinoma of the esophagus allows a certain opinion to be formed on the advantages and shortcomings of this surgical intervention. In esophageal carcinoma with its proximal boundary within the range of the retropericardial segment of the esophagus, a left abdominothoracic approach (Garlock's operation) is adequate in resection of the esophagus in conformity with the oncological principles and allows the formation of the esophagogastric anastomosis at the level of the arch of the aorta without particular technical difficulties. Reduction of the time needed for the operation, determination of the resectability of the esophageal tumor before mobilization of the stomach are obvious advantages of the abdominothoracic approach.