[Features of surgical treatment of central tracheal and bronchial carcinoid]. / Osobennosti khirurgicheskogo lecheniya tsentral'nogo kartsinoida trakhei i bronkhov.

OBJECTIVE: To analyze features of surgical treatment of central tracheal and bronchial carcinoid. MATERIAL AND METHODS: A retrospective analysis included 115 patients with carcinoid tracheal and bronchial tumors who have been examined and treated from 1974 to the present. The majority of patients (97, 84.3%) had central form of carcinoid of the trachea, bronchi and lungs. Of these, 95 (97.9%) ones underwent surgical treatment. RESULTS: We used pre- and intraoperative diagnostics including bronchotomy. This approach provided organ-sparing surgery with resection and reconstruction of the bronchi and trachea in 71 (74.7%) patients including complete preservation of lung function in 20 (21.1%) cases and lobectomy/segmentectomy with resection and reconstruction of the bronchi in 51 (53.7%) cases. Two patients underwent pneumonectomy with wedge-shaped and marginal resection and reconstruction of tracheal bifurcation. Postoperative complications developed in 4 (4.2%) patients, and 2 (2.1%) ones died. Overall 5-year survival after radical surgeries was 89.2% (100% in typical carcinoid and 78.0% in atypical carcinoid).

[Hardware anastomosis in stomach cancer surgery]. / Apparatnyi anastomoz v khirurgii raka zheludka.

AIM: To choose optimal technique of esophagojejunostomy in stomach cancer regarding reliability, functionality and simplicity. MATERIAL AND METHODS: 145 patients with stomach cancer grade I-IV were enrolled. They were divided into 2 groups depending on the type of the anastomosis (manual or hardware). RESULTS: There were no significant differences between groups in the incidence of anastomosis failure, anastomotic stricture and reflux-esophagitis in long-term postoperative period. At the same time, duration of reconstructive stage with hardware anastomosis was 26±11.3 min, whereas for manual stage - 72±21.9 min (p<0.0001) depending on surgeon's experience. CONCLUSION: Hardware circular anastomosis in most clinical cases is an alternative to conventional manual anastomosis with the same reliability, safety and functionality. Moreover, principles of hardware anastomosis are the same for open and endoscopic surgery that makes this technique universal and necessary for wide development.

[Adenocystic carcinoma of the trachea]. / Adenokistoznyi rak trakhei.

It is presented 40-years experience of tracheal adenocystic carcinoma diagnosis and management in 144 patients. Peculiarities of clinical course and choice of diagnostic and therapeutic measures are discussed in relation to stenosis and hypoxia degree and severity of accompanying inflammatory complications of trachea, bronchi and lungs. Technical tools and original methods of resection and reconstruction of trachea and it's bifurcation after extended lung resection are described. Surgical management is carried out in 96 patients: all patients underwent circular resection of trachea (77) or it's bifurcation (19). Morbidity rate was 22.9% and mortality - 3.1%. Additional radiotherapy was carried out in 50 patients. 41 patients underwent radiotherapy alone. Radiotherapy improves remote results of management. 5-and 10-year survival rate was 78.3±6.1 and 45.9±7.9% after surgery alone, 92.0±3.9 and 77.1±6.5% after combined treatment and 76.4±6.5 and 55.0±10.7% after radiotherapy alone respectively.

[Results of surgical and combined treatment for nonsmall cell lung cancer with postoperative radiation therapy in a mode of hypofranctionation. Post II. Relapse-free survival and survival without locoregional recurrence].

Conducting postoperative radiotherapy in a mode of hypofranctionation with SFD-3Gy to TFD-36-39Gy (EQD2 = 43,246,8Gy) in combined treatment of patients with non-small cell lung cancer allows significantly increasing a 5-year disease-free survival at IIB-IIIB stages of the disease (pN1-2) as well as the central cancer, squamous cell morphological type of tumor after surgery in a volume of lob-bilobectomy. The clearest effect of postoperative radiotherapy is assessed by survival without locoregional recurrence where radiation therapy in the adjuvant setting allows achieving a statistically significant increase in local control of the disease to the level of 85-95% regardless of stage of the disease, tumor size, regional lymph nodes lesion and the surgical treatment.

[Current problems of postoperative radiotherapy for non-small cell lung cancer].

The review considers the history of evolution and the present state of the problem of postoperative radiotherapy for non-small cell lung cancer. The randomized trials and meta-analyses given in recent publications provide evidence that it should be used in radically operated patients with morphologically verified regional metastases. The paper also shows promises of hypofractionation and a postoperative radiation/chemotherapy ratio for non-small cell lung cancer.

[Results of surgical and combined treatment for non-small cell lung cancer with postoperative hypofractionated radiotherapy: overall and disease-specific survival].

Compared with surgical treatment the combined treatment of patients with non-small cell lung cancer accompanied by post-operative radiotherapy in the mode of hypofractionation from 3 Gy to SOD-36-39 Gy (EQD2 = 43,2-46,8 Gy) allowed statistically significant increasing a 5- and 10-year overall and disease-specific survival in patients with metastases to regional lymph nodes (pN1-2). The increase of overall and disease-specific survival was also observed in patients older than 60 years with the worst initial status (70-80 by the Karnofsky scale), II stage of disease, peripheral cancer and adenocarcinoma however for these groups survival differences did not reach a statistically significant level. The presented method of postoperative irradiation did not have severe toxicity and did not lead to a decrease in survival of elderly and functionally debilitated patients.

[Specifics of surgical treatment of stomach cancer in patients 70 years of age and older].

The paper deals with immediate and end results of surgical treatment of 435 elderly patients (70-years-old or older) with gastric cancer and the specifics of postoperative complications influencing the postoperative course of the disease. Metastasis to the regional lymph nodes appeared to be a prognostic factor of crucial importance in the latter period: 5-year recurrence-free (N0) survival was 60.3% +/- 5.2 vs. 17.6% +/- 10.3 (in 1-6 lymph nodes) and 5.2% +/- 5.0 (in 7-15 lymph nodes) (N1).

[Features and risk factors of post-mastectomy, locally advanced breast cancer relapse].

Multivariate analysis of risk of locally-advanced breast cancer IA-IIIB progression was carried out in 444 patients 10 years after mastectomy in the framework of two randomized studies. Combination therapy (median 156.3 months) included mastectomy, different modalities of neoadjuvant and adjuvant chemohormonal and radiotherapy.

[Surgical and combined treatment of lung cancer].

A 40-year experience of use of surgical and combined treatment of lung cancer is discussed (n=3,687; surgery--26.7%, combined treatment--73.3%). Eight protocols were used depending on stage of tumor, dose of radiation and fractionation pattern. Role and effectiveness of reconstruction surgery involved in lung cancer treatment are established and end results vis-à-vis main prognostic factors presented. Failed treatment and rationale for systemic chemotherapy as a component of combined treatment are evaluated.

[Surgical treatment of cancer of the stomach in patients over 70 years].

Surgical treatment was performed in 322 patients over 70 years with cancer of the stomach. Radical operation was made in 220 (68.3%) patients: subtotal distal resection -- in 137, subtotal proximal resection -- in 18, gastrectomy -- in 55, extirpation of the gastric stump -- in 10. Symptomatic and test surgeries were performed in 102 (31.7%) patients. Postoperative complications were seen in 16,1+/-2,1% cases, lethality was 6.8+/-1.4%. Complications after radical resections were seen in 16.4+/-2.5% patients, lethality was 5.0+/-1.5%. The rate of purulent complications was maximal (8.4%). Cardiovascular complications and coagulopathies (4.7%) were the main causes of lethal outcome (in 11 of 15 patients). Score scale of assessment of postoperative risk was developed. Five-years survival in stage I cancer of the stomach was 62.8%, stage II -- 42.6%, III -- 16.7%. Immediate and long-term results demonstrate necessity of radical surgical treatment of patients with cancer of the stomach over 70 years depending on the disease stage and risk factors.

[Results of surgical treatment of lung cancer in patients over 70 years old]. / Rezul'taty khirurgicheskogo lecheniia raka legkogo u bol'nykh v vozraste starshe 70 let.

Results of surgical treatment of 345 patients (210 men--61%; 135 women--39%) over 70 years with non-small-cell lung cancer were analyzed. Central lung cancer was diagnosed in 141 (40.9%), peripheral--in 204 (59.1%) patients. Squamous cell cancer was seen in 233 (67.3%), glandular--in 67 (19.4%), dimorphic--in 22 (6.5%), large-cell--in 23 (6.8%) patients. Stage I of the disease was diagnosed in 121 (35.1%); stage II--in 49 (14.1%); stage III--in 175 (50.8%) patients. Rate of postoperative complications in the study group was 27.8%, lethality--6.4%. The highest lethality was after combined pneumonectomy. The most frequent postoperative complications were pneumonia (7.5%), arrhythmia (10.1%), pulmonary-heart insufficiency (4.9%). Five-year survival after radical surgery in patients over 70 years with lung cancer was 49%, in patients with stage I of the disease this parameter was the highest--71.4%.

[Lung cancer: 30-year experience of surgical and combined treatment]. / Rak lëgkogo: 30-letnii opyt khirurgicheskogo i kombinirovannogo lecheniia.

6,212 lung cancer patients have been examined and treated. The data on surgical and combined treatment of 2,702 patients have been analyzed. Postoperative complication incidence has dropped to 5.4% in recent years. End results have improved due to use of organ-saving, reconstructive and plastic procedures for the bronchi and trachea in conjunction with radiotherapy.

[Early peripheral cancer of the lung: long-term results of combined therapy using sparing resection techniques]. / Rannii perifericheskii rak legkogo: otdalennye rezul'taty kombinirovannogo lecheniia s ispol'zovaniem ékonomnykh rezektsii.

Two hundred-thirty patients were operated on for peripheral lung cancer TIN0M0 in 1960-1990. Pheumonectory was performed in 3 cases, lobectomy-123, segmentectomy-40, wedge-like resection-57 and removal of tumor-in 7 cases. Limited resection in 20 patients was not followed by radiation therapy, Radiation treatment was given to 15 patients preoperatively, 53-postoperatively and 16 patients-pre-and postoperatively, Five-year survival after combined treatment was recorded in 70.5%, while without this treatment-68.7%. Local recurrences following limited intervention were usually detected 3-5 years later, regional and distant metastases developing within the first 24 months. A reverse correlation was established between extent of surgery and local recurrence incidence. Reoperation such as lobectomy or pneumonectomy is feasible in cases of timely diagnosis. The highest 5-year survival rates were registered for segmentectomies carried out in combination with postoperative radiotherapy (77.2%). Prognosis proved best in cases of adenocarcinoma and tumor arising in the cicatrix. Paliative surgery appeared preferable for primary tumor 1.5 cm in diameter and less. Even in small-size malignancy, removal of tumor is not radical enough, Wedge-like resection is admissible in small-size subpleural lesions only. Preoperative radiotherapy results proved inferior to those of other procedures of combined treatment. Pronounced radiation-induced pneumonitis involving re-hospitalization for symptomatic treatment occurred in 7 (5.5%) cases of lobectomy combined with radiotherapy and in 2 (1.9%) cases of limited resection.

[Morphological evaluation of structural changes in the tracheal wall at the site of braided and monofilament sutures in experimental animals]. / Morfologicheskaia otsenka strukturnykh izmenenii stenki trakhei v oblasti shvov pletenym i monofilamentnym materialami v éksperimente.

To select the most adequate suture material for tracheal surgery the authors studied tissue specimens of tracheal anastomoses from 18 guinea pigs. Scar replacement of the cartilage plate occurred more frequently in monofilament prolene suture compared to braided vicryl. Tracheal wall structural changes were related to rigidity of the suture material. The rigidity was higher in monofilament material and increased with the filament thickness.

[Multiple primary malignant neoplasms and survival of patients with stage-I lung cancer]. / Pervichnaia mnozhestvennost' zlokachestvennykh opukholei i vyzhivaemost' bol'nykh rakom lëgkogo I stadii.

The study group included 2161 patients operated on in 1968-1990. Tumors stage I were morphologically confirmed in 910 cases (T1S-3, T1-375 and T2-532). 827 patients survived 5 years (90.9%); 551 patients-10 years (60.3%). Primary multiple neoplasms (PMN) of different localization were detected in 96 (10.6%) patients with stage I tumors. Thirteen patients (13.5%) died of progression of a second tumor; 17 (17%)-of other causes. Average 5-year survival was 65%, 10 years-53%. These indices in 96 patients with PMNs were 73 and 53%, respectively. Relative risk of PMN in lung cancer was found to be in direct correlation with survival time and to depend, to a large degree, on tumor extension. When PMNs are detected early and treated radically, new primary tumors emergence does not significantly in lung cancer stage I. Preliminary results showed chemotherapy (neoadjuvant one included) to lower the risk of PMN in lung cancer stage I. The most plausible causes of enhanced survival of patients with PMNs are discussed.

[Reconstructive surgeries of lung cancer]. / Rekonstruktivnaia khirurgiia raka lëgkogo.

The proportion of reconstructive operations on the bronchi and tracheal bifurcation at the current level of the development of surgery for lung carcinoma is sufficiently high. Among 2,075 lung resections performed at our clinic reconstructive operations were carried out in 31.6% of cases. The success of reconstructive surgery in lung carcinoma is determined to a great measure by the correct choice of the indications for this type of surgical treatment, preoperative management, the level of surgical techniques and anesthesiological service, and postoperative management of the patients. Five-year survival depending on the stage and method of treatment after lob-, bilobectomy with resection and plastics of the bronchi and tracheal bifurcation was 28.3-67.4%, and after pneumonectomy with resection of the bifurcation of the trachea it ranger from 16.2 to 43.3%.