[Surgery of primary tracheal tumors]. / Khirurgiya pervichnykh opukholei trakhei.

OBJECTIVE: To determine the main forms of primary tracheal cancer (PTC), to specify the indications for various surgeries in these patients depending on extent and localization of lesion. MATERIAL AND METHODS: There were 263 PTC patients. Benign tumors were diagnosed in 68 (25.9%) patients, malignancies - in 195 (74.1%) cases. Tracheal cancer includes 3 basic morphological variants - adenocystic cancer (49.7%), carcinoid (18.7%) and squamous cell carcinoma (19.0%). Other forms of malignancies were much less common. We applied endoscopic intraluminal and open surgeries. In malignant PTC, open surgeries were performed in 165 (84.6%) out of 195 patients. Baseline palliative endoscopic treatment was performed in 30 patients. They underwent airway recanalization (with subsequent tracheal stenting in 19 patients). Endoscopic resection was preferred for benign tumors. RESULTS: Twenty (12.1%) patients died after open surgery, and 1 (3.3%) patient died after endoscopic procedure. Most lethal outcomes occurred in early years of development of tracheal surgery. The causes of mortality were tracheal anastomotic failure in 12 patients, pneumonia in 6 patients, and arterial bleeding in 2 patients. Severe postoperative period was observed in all 3 patients after tracheal replacement with a silicone prosthesis. Long-term treatment outcomes depended on morphological structure of PTC. Favorable results were observed in patients with neuroendocrine tumor (carcinoid), worse outcomes in adenocystic cancer and unfavorable results in squamous cell carcinoma (p<0.0013). Five-year survival rates were 75%, 65.6%, and 13.3%; 10-year survival rates were 75%, 56.2%, and 13.3%, respectively. These outcomes after combined treatment of primary tracheal cancer were significantly better compared to lung cancer (p<0.05 when compared to global data). CONCLUSION: Treatment of primary tracheal cancer should be based on classical principles of modern oncology (combined therapy, tumor resection with lymphadenectomy). Open and endoscopic interventions are justified. PTC is characterized by more favorable outcomes compared to lung cancer. It is difficult to analyze long-term results in tracheal cancer depending on various features of tumor process due to small number of observations. Accurate conclusions require multiple-center studies, preferably with international participation, which can convincingly prove certain concept.

[Postoperative drainage of the pleural cavity with aspiration of the contents by high-tech mobile devices]. / Posleoperatsionnoe drenirovanie plevral'noi polosti s aspiratsiei soderzhimogo vysokotekhnologichnymi mobil'nymi apparatami.

Postoperative drainage of pleural cavity is currently a common component of treatment of patients with surgical diseases of thoracic organs. Peculiarities of suctioning (aspiration parameters, passive drainage or active aspiration, the degree of discharge in the device-pleural cavity system, as well as the possibility of early patient activation, no need to «attach¼ him to the electric stationary suction) remain topical and continue to be discussed. New devices - aspirators, including mobile ones with digital control and rarefaction control component, appear in the market. MATERIAL AND METHODS: Between May and September 2021, 65 patients aged from 23 to 88 years with various oncological and non-oncological diseases of the thoracic cavity followed by drainage underwent resection operations with a volume less than pneumonectomy or lung decortication for empyema, parietal pleurectomy for recurrent pneumothorax. Six patients (4 after pneumonectomy and one with postoperative complications (1 after retoracotomy for hemothorax and 1 after laparoscopic cholecystectomy for acute destructive cholecystitis in the immediate postoperative period) were excluded from the study. The patients were divided into 2 groups. The first group consisted of 22 patients in whom in the early postoperative period we used continuous active pleural content aspiration with the help of high-tech mobile devices Atmos. The second group included 37 patients in whom we used drainage by means of medical suction of Lavrinovich or Visma-Planar design (Belarus). RESULTS AND CONCLUSION: Soft drainage by modern systems of pleural cavity content evacuation provides the best conditions for stopping air leakage from the lung tissue as well as for preventing pneumothorax when transporting a patient from the operating room and around the clinic for examination. The early activation of the patient with the connected mobile digital aspirator not only promotes the Fast-track surgery concept but also the ERAS program, i.e. accelerated rehabilitation, as recommended by the European Society of Thoracic Surgeons (ESTS). These designs also have advantages over stationary devices, such as subjective factors based on the relative ease of operation of mobile systems in their use, accessibility not only for medical staff, but also for the patient himself.

[Surgical treatment of giant thymoma complicated by intrathoracic compression syndrome]. / Khirurgicheskoe lechenie gigantskoi timomy, oslozhnennoi kompressionnym sindromom organov grudi.

The problem of giant chest tumors is still actual despite the progress in diagnostics of intrathoracic cancer. Surgical treatment of giant tumors should always be considered as a part of combined antitumor treatment. Large tumor is not a contraindication for surgery per se. The results of explorative thoracotomy may be assessed in expert centers once again if redo surgery may be followed by favorable outcome. These operations require the coordinated work of the entire operating team.

[Giant posttraumatic diaphragmatic hernia in 17 years after rupture of the diaphragm]. / Lechenie gigantskoi posttravmaticheskoi diafragmal'noi gryzhi cherez 17 let posle razryva grudobriushnoi pregrady.

Blunt chest trauma followed by diaphragm rupture is a severe injury requiring surgical correction both in acute and long-term periods. Posttraumatic diaphragmatic hernia is dangerous by infringement of dislocated organs. Thanks to adaptive mechanisms of the organism, patients with non-functioning half of the diaphragm have a good quality of life for a long time. Symptoms (respiratory disorders and arrhythmia, predominantly) occur over time in patients with concomitant diseases and impaired function of vital organs. At the same time, simultaneous thoracic and abdominal surgery is possible. Thoracotomy is advisable for injury of the right half of the diaphragm, thoracotomy and laparotomy - for injury of the left half. It is presented case report of diaphragm repair by primary suture without application of strengthening materials in 17 years after complex trauma. In this case, diaphragm function was restored that resulted improved quality of life.

[Postoperative bleeding in tracheal surgery].

AIM: Tracheal surgery became relatively safe with development of thoracic surgery, endoscopy and anesthesia. However, life-threatening vascular complications especially arrosive bleeding from great vessels play important role in the structure of postoperative complications. It is a major cause of hospital mortality after tracheal surgery. MATERIAL AND METHODS: Since 1963 to 2013 867 patients with cicatrical tracheal stenosis were treated. Their age ranged from 8 to 77 years. Bleeding was the main cause of death after tracheal surgery. It occurs in 31 patients among whom 22 died. 9 patients are alive. There was bleeding from small cervical vessels and carotid artery in 5 and 2 patients respectively. All patients with bleeding from brachiocephalic trunk died except 2 patients who underwent complex vascular reconstructions and recurrent complications were prevented. Vascular complications occurred after both circular tracheal resection with the anastomosis (19 patients) and tracheoplasty followed by airway lumen formation on T-shaped tube (in 11 cases) or endoscopic treatment (in 1 patient). Postoperative complications were predominantly arrosive and accompanied by wound infection or severe purulent tracheobronchitis. Blood loss was relatively small in all patients and asystole was caused by blood asphyxia in died patients. Therefore, firstly respiratory tract lumen should be isolated from source of bleeding. 22 patients were urgently operated. Intraoperative death was observed in 6 cases, 7 patients died within 2-31 days. In 7 other patients cervical soft tissues, thyroid artery collaterals and carotid artery were origin of bleeding. RESULTS: Final bleeding stop was performed with good immediate and long-term results in all cases. Final bleeding stop usually requires complex vascular reconstructions and it is difficult to predict their outcomes. It is necessary to prevent intraoperative bleeding because of unsatisfactory results of vascular complications management. So careful manipulations with vessels and their isolation from the tracheal anastomosis and tracheostomy channel with patient's own tissues are obligatory.