[Optimization of treatment methods of surgical complications in lung cancer].

The present report analyses the immediate and long-term results of treatment of surgical complications in 998 patients with lung cancer. There were complications in 37,5% of the cases, with a fatality rate of 14,7%. The most frequent complications were as follows: postoperative empyema with bronchopleural fistula (41,3%), bleeding (12,0%), pneumonia (9,8%), pulmonary arteries embolism (8,1%) and heart rhythm disorders (8,1%). Adjuvant and neoadjuvant treatment does not increase the rate of surgical complications as compared to just surgery alone (p = 0,1). Postoperative empyema with bronchopleural fistula requires intensive therapy, affects the quality of life of patients but does not decrease survival rates as compared to patients at the same stages of disease with uncomplicated course (p = 0,001). Timely drainage of pleural cavity accompanied by its adequate sanation does not differ (p = 0,1) from usage thoracoplasty (MS 29,9 months to 33,2 months).

[Rationale for surgical treatment of cancer of the lower pulmonary lobe with consideration for regional metastatic spread]. / Obosnovanie taktiki khirurgicheskogo lecheniia raka lëgkogo nizhnedolevoi lokalizatsii s uchëtom osobennostei regionarnogo metastazirovaniia.

Optimal extent of surgery for lung cancer is determined to a great degree by lymph drainage and regional metastases vis-a-vis tumor localization in the lobes. Data on surgical treatment of 505 cases of cancer of the lower lobe are presented. The study established such peculiarities of metastatic spread to mediastinal lymph collector as relatively frequent involvement of the lower mediastinal lymph nodes ("jumping" metastases included) and greater likelihood of spread to the superior mediastinal lymph nodes when those of radix pulmonis are involved. The latter should be interpreted as an indicator of lower lobe involvement. We established the significance of relatively worse prognosis for mediastinal lymph node involvement as well as high frequency of intrasternal recurrences of tumors located in the left lung. The prevailing evidence on partial resections of the right lung rather than lower bilobectomy and the good results of bilobectomies for stage T1-3N1-2 tumors suggest that conservative treatment might offer more advantage in managing cancer of the lower lobe of the right lung. Extended surgery entails lower incidence of intrasternal recurrence and is more effective when used to treat right-lung tumors.

[Influence of growth rates of local recurrences and in-transit metastases on survival of patients with cutaneous melanoma]. / Vliianie kineticheskikh kharakteristik mestnykh retsidivov i tranzitnykh metastazov na vyzhivaemost' bol'nykh melanomoi kozhi.

The growth rates of local recurrences and in-transit metastases of skin melanoma were assessed in 271 patients. Median growth rate in the course of chemotherapy was 0.02 a day--1 which corresponded to a doubling time of 34.7 days. Median survival time for patients with local recurrences and in-transit metastases was 22.6 months, 12-month survival--70.1%, 5-year--19.6% and 10-year--9.9%. Growth rate appeared to be the most significant prognostic factor; similarly important were tumor volume, relapse-free interval, tumor mitotic rate, site and number of recurrences. The following additional characteristics of tumor growth rate have been suggested: maximum growth rate and doubling time limit, to assess the rates of secondary tumor focus development.

The cytogenetic investigation on peripheral blood lymphocytes of a patient with thyroid cancer.

The cytogenetic investigation of a patient with follicular cancer in the left lobe of the thyroid gland was made. The study was carried out on blood lymphocytes as described earlier (1) before and after hemithyroidectomy and in different terms during the therapeutic treatment. The great number of cells with polyploid and hyperaneuploid (13% and 5% correspondingly) were revealed in the patient on the day before the operation and confirmed malignant character of the tumour, which was confirmed histologically. It is believed that cytogenetic markers as trisomies 4-th chromosome or/and X chromosome, detected in hyperaneuploids cells before the beginning of a treatment, might be specific markers for follicular thyroid cancer (FTC). The cytogenetic examination of the patient, carried out on peripheral blood lymphocytes in dynamics, allowed to observe changes of background chromosomal breaches under influence of surgical and therapeutic treatment and to estimate their efficiency.

[Specifics of thyroid status and their clinical significance in primary and recurrent thyroid cancer]. / Osobennosti tireoidnogo statusa i ikh klinicheskoe znachenie pri pervichnom i retsidiviruiushchem rake shchitovidnoi zhelezy.

The results of an evaluation of thyroid homeostasis in 54 patients with thyroid cancer (TC), 12-thyroid adenoma (TA), 10-non-toxic nodular goiter (NTG) and 39 healthy controls are discussed. It was demonstrated that assays of blood serum levels of thyrotropic hormone (TTH), thyroxin (T4), triiodothyronine (T3) and thyroglobulin (TG) are useless in diagnosing TC. However, it was confirmed that routine assays of blood serum-TTH, T4 and T3 levels are needed to evaluate the effect of post-operative substitution hormone therapy. Furthermore, the presence of recurrence or metastasis was indicated by an elevated concentration of blood-TG post-operatively if it was high pre-operatively. Post-operatively, TTH levels soared up in thyroid cancer and adenoma patients, reached their peak one month after surgery and then came back to normal while blood-TG concentration dropped to normal within 6-12 months. Unlike TA patients, blood-TG showed a continuous rise in those with TC. Ten years after surgery, blood-TTH levels in TC patients, who had received substitution hormone therapy, were much lower than in those without it. Similarly, the recipients of hormone therapy showed relatively lower T3 (6 months after operation) and TG (5 years after surgery) levels. Blood-TTH in overweight (Broca index > 20%) patients with TC was much higher than in those overweight less than 20%, 2 years after surgery. Elevated concentrations of blood-TTH and T3 were recorded in radically-treated patients with TC recurrences and metastases.

[Significance of adjuvant radiotherapy in the surgical treatment of patients with non-small-cell lung cancer]. / Znachenie ad'iuvantnoi luchevoi terapii pri khirurgicheskom lechenii bol'nykh nemelkokletochnym rakom lëgkogo.

The study comprised 702 patients radically operated on for non-small cell cancer of the lung: surgery alone--351; radiation + surgery --110; (Eighty-seven patients of the latter group received an intensive course of radiation with a total target dose (TTD) of 20 Gy); surgery + fractionated radiation with TTD 50-55 Gy--195; radiation + surgery + radiation--46. No significant increase in overall or stage-related survival was registered for application of either modality as compared with controls. To establish indications for adjuvant radiotherapy, a prognostic factor study was undertaken using the regression model of Cox. The presence of metastasis in mediastinal nodes (N2) is considered the main indication for combined treatment. In the absence of metastasis in the regional nodes (N0) or in case of metastatic involvement of the nodes of the radix pulmonis (N1), adjuvant radiotherapy was not followed by a significant increase in survival rates even in cases of extensive local primary tumor (T3) and other unfavorable factors. Surgery + radiation or radiation + surgery + radiation for extensive non-small cell disease (T1-3N2M0) led to a significant (p < 0.05) rise in overall and recurrence-free survival rates and reduced the risk of local recurrences as compared with surgery alone.

[Comparative evaluation of the effectiveness of surgical treatment and pulsed laser therapy for malignant skin melanoma, stage I]. / Sravnitel'naia otsenka effectivnosti khirurgicheskogo lecheniia i impul'snoi lazerterapii zlokachestvennykh melanom kozhi I klinicheskoi stadii.

The report deals with a comparison of the effectiveness of surgical (300 cases) and pulsed laser treatment (wavelength of 1,060 nm, pulse duration-1 ms) (230 cases) for skin melanoma, stage I, degree I-IV invasion (Clark). All patients were followed up for 5 years and longer. Following laser therapy, local recurrencies were detected in 0.75% while regional and distant metastases were identified in 24.8%; in 45.6%, they were detected within the first 12 months of follow-up. Treatment by radiation from a powerful pulse source proved effective for cutaneous melanoma, stage I, degree I-IV invasion (Clark). Total 5-year survival was 83.2%. All patients with degree I invasion have survived 5 years, and are still alive, degree II-92.3%, degree III-85.7% and degree IV-80.5%. For surgical treatment, total 5-year survival was 78.7%. All patients with degree I invasion have survived 5 years and are still alive, degree II-85.5%, degree III-78.9% and degree IV-68.4%.

Geographical distribution of lung cancer in the USSR.

During recent years medico-geographical studies on lung cancer in the USSR have been intensified. The results of these studies are reflected in works on the geographical distribution of lung cancer and on the influence of unfavourable natural-economic factors upon lung cancer incidence. The steady increase in lung cancer morbidity and mortality throughout the world is one of the urgent problems of today. Numerous studies have been carried out, and these have identified several aetiological factors which play a certain role in lung cancer development (smoking, occupational hazards, air pollution by industry and traffic). These studies have shown lung cancer to be one of the cancers most closely associated with environmental conditions. Lung cancer is considered to be a disease of the male population inhabiting highly industrialized cities and countries. However, lung cancer incidence has also been increasing recently in the female population of different countries. (V. Merabishvili, G. Tserkovny, 1981) Different levels of morbidity and mortality from lung cancer throughout the world make it necessary to undertake comprehensive studies on the complicated and ever-changing relations between the health status of the population and the effect of natural and economic factors.

Delayed regional lymph node dissection in stage I melanoma of the skin of the lower extremities.

Results of a prospective randomized clinical trial conducted by the WHO Collaborating Centers for the Evaluation of Methods of Diagnosis and Treatment of Melanoma are reported. Five-hundred-fifty-three Stage I patients whose limbs were affected entered the study; 267 were submitted to wide excision and immediate node dissection and 286 had wide excision and node dissection at the time clinically positive nodes were detected. Survival curves of the two treatment groups could be superimposed. No subsets of patients benefitted from immediate node dissection. The authors conclude that delayed node dissection is as effective as the immediate dissection in Stage I melanoma of the extremities if the patient can be checked every three months. If the quarterly follow-up is not guaranteed, immediate node dissection is advisable, at least for melanomas thicker than 2 mm.

Laser radiation therapy of skin melanoma.

Pulsed neodymium laser radiation was used for the treatment of 79 patients with cutaneous melanomas and 19 patients with melanoma metastases to the skin. The patients were followed up from 3 months up to 8 years. During this period local recurrences were detected in 2 cases. Out of 70 patients with cutaneous melanomas, who by the start of the treatment had no metastases in the regional lymph nodes or distant organs, metastases developed in 15 patients (21.4%). There are all reasons to consider pulsed laser radiation an effective means of treatment of some forms of skin melanoma.

On the end results of surgical treatment of lung cancer patients depending on the type of anesthetic agent.

The end results of therapy of 346 patients with lung tumors, treated with surgery alone, are compared, depending on the type of general anesthetic agent used. Anesthesia was induced with ether in 220 patients, halothane in 103, and neuroleptanalgesia in 23 cases. All the anesthetic agents were administered in a mixture with nitrous oxide. The basic characteristics of patients, who were divided on the basis of anesthetic agent, were identical. The results show that type of anesthesia during surgical treatment for lung tumor has an effect on the end results of therapy, and the best prognosis is ensured when halothane is used. Further analysis established that the end results of surgery with halothane anesthesia are improved, when partial resection rather than radical pneumonectomy is performed, at stage 2 of malignant disease and when metastases into regional lymph nodes are absent. Such improvement may be explained by stimulation of the hypothalamo-pituitary-adrenal system as well as a relatively lower degree of immunosuppression and development of conditions more adverse for implantation of circulating tumor cells than in the case of ether or neuroleptanalgetic anesthesia.

Stage I melanoma of the limbs. Immediate versus delayed node dissection.

553 patients with stage I malignant melanoma of the limbs entered a prospective randomized clinical trial carried out by the W.H.O. Collaborating Centres for Evaluation of Methods of Diagnosis and Treatment of Melanoma from September 1967 to January 1974. 286 patients were submitted to wide excision of primary and node dissection at the time as appearance of regional lymph node metastases and 267 to wide excision and immediate node dissection. Survival was identical in the 2 groups. Different subsets of patients were evaluated to assess whether some groups of patients may benefit from immediate node dissection. As regards sex, females and a significantly higher survival rate than males (p < 0.05), but results were not improved by immediate node dissection. Maximum diameter and elevation of primary melanoma were significantly related to survival but also in these cases immediate node dissection did not achieve better results. 63 patients had an excisional biopsy of their melanoma within 4 weeks before final treatment. This procedure did not worsen survival and also in this case immediate node dissection did not improve survival. 273 cases were classified according to histologic type: survival of superficial spreading and nodular melanoma was not different at a statistically significant level after the 2 treatment modalities. 325 cases were considered classifiable according to Clark's levels, out of these 165 were submitted to immediate node dissection. Neither level III nor level IV cases showed higher survival rate after immediate node dissection. Maximum tumor thickness according to Breslow was evaluated in 338 cases: 188 were submitted to wide excision and immediate node dissection. In no clusters of thickness did the enlarged surgical procedure achieve better results. The authors conclude that there is good evidence that in stage I melanoma of the extremities delayed dissection.

The potentialities and prospects for surgical methods of diagnosis of cancer of the lung.

Surgical methods of diagnosis make it possible to determine in patients with lung cancer the actual local extension of tumour and its metastatic foci. The diagnostic thoracotomy plays an important role in the complex diagnosis of lung cancer. Diagnostic thoracotomy has been performed in 109 out of 1215 patients with lung cancer and other lung lesions suspicious for cancer. Primary lung cancer, mostly at early stage, was detected in 50 out of 109 patients. Among 308 patients who had been subjected to Daniels operation, metastases were revealed in 130 cases (42.2%); prescalene lymph nodes were found inpalpable in 12.4% and palpable in 64.4% of cases. Mediastinoscopy carried out in 262 patients revealed metastases in 36.2% of cases. Parasternal mediastinotomy allowed definition of the degree of tumor extension in 49.5% of cases. Application of laparoscopy and laparotomy revealed metastases in the organs of the abdominal cavity and retroperitoneal space in 13.5% of patients. Results of studies show a definite relationship between the frequency of metastases development in the lymph nodes and distant organs and tumor site as well as clinico-anatomical forms and morphological structure of tumor. Application of surgical diagnostic methods should be done according to strict indications.

Laser therapy of human benign and malignant neoplasms of the skin.

Radiation of a powerful neodymium-doped glass pulsed laser, Pulsar-1000 type, has been used for therapy of 235 patients with a total of 257 precancerous lesions and benign tumours, 76 basal and squamous cell carcinomas, 13 melanoblastomas and 59 metastatic melanoblastomas in the skin. Energy density used in the treatment of precancerous lesions and benign tumours was 200-450 J/cm2, in basal and squamous cell carcinomas 400-500 J/cm2, in melanoblastomas and their skin metastases 800-1 000 J/cm2. The results have been satisfactory.