[Modern aspects of organ-preserving surgery for laryngeal cancer]. / Sovremennye aspekty organosokhranyayushchei khirurgii raka gortani.

A review of the literature on modern aspects of organ-preserving surgery for laryngeal cancer - endolaryngeal and open resections - is presented. The indications for these operations are determined depending on the location and extent of the tumor, as well as on the anatomical features. The advantages and disadvantages of each method, complications, functional and oncological results are shown.

[The functional outcomes of open vertical resections of the larynx]. / Funktsional'nye rezul'taty posle otkrytykh vertikal'nykh rezektsii gortani.

The early diagnostics of the malignant tumours of the larynx provides a basis for the timely beginning of their conservative treatment and endolaryngeal surgical interventions. However, neither the conservative treatment nor endolaryngeal surgery ensures the sufficiently efficient treatment when the tumour spreads over the anterior commissure, subglottic space, and/or laryngeal ventricles. The open surgical resection of the larynx is indicated for the management of the patients presenting with this condition. Our experience is based on the performance of vertical resection of the larynx in 98 patients including the fronto-lateral and extended fronto-lateral interventions in 63 and 35 of them, respectively. The formation of the malignant tumour is known to result in the alteration of the acoustic characteristics of the patient's voice as compared to the initially normal ones in the preceding period. Specifically, the mean values of the fundamental tone frequency increases, the intensity of the sound signal decreases, and the amplitudes of the fundamental tone harmonics tend to be reduced. At the same time, both the dispersion and the variability of the acoustic characteristics being studied undergo an enhancement in comparison with the normal values. Open resection of the larynx with its simultaneous endoscopic correction made it possible to restore the respiratory and vocal functions in 90.8% and 92.1% of the treated patients respectively.

[The systemic approach to the rehabilitation of the patients presenting with laryngeal cancer after the resection of the organ and laryngectomy with tracheoesophageal by-pass and endoprosthetics]. / Sistemnyi podkhod k reabilitatsii bol'nykh rakom gortani posle rezektsii organa i laringektomii s trakheopishchevodnym shuntirovaniem i endoprotezirovaniem.

The objective of the present study was to enhance the effectiveness of rehabilitation of the patients presenting with laryngeal cancer after the resection of the organ and laryngotomy with tracheoesophageal by-pass and endoprosthetics. Our experience in this field is based on the treatment of 102 patients. They were distributed by the nosological forms as follows: primary laryngeal cancer in 97 patients including T1NoMo - 8 (8.2%), T2NoMo - 63 (65%), T3NoMo - 18 (17.6%), T2N1Mo - 1 (0.9%), T4NoMo - 3 (2.9%), and T4N1M0 - 4 (3.9%), root of the tongue cancer spreading over the vestibular part of the larynx in one patient, laryngeal sarcoma in one patient, relapse of cancer following the full-dose radiotherapy and organ-sparing surgery in 3 patients. Laryngeal resection was performed in 83 patients; 19 patients underwent laryngectomy with tracheoesophageal by-pass and endoprosthetics using a domestically manufactured voice prosthesis. The systemic approach to the rehabilitation of the patients and the use of the proposed treatment algorithm made it possible to restore the function of the larynx by means of organ-sparing surgery in 79 (95.1%) of the 83 patients. The vocal function in the patients following laryngectomy with tracheoesophageal by-pass and endoprosthetics was restored in 18 (94.7%) of the 19 patients.

[The algorithm for rehabilitation of the patients presenting with laryngeal cancer following open functionally sparing operations].

The objective of the present study was to increase the efficiency of the treatment of the patients presenting with laryngeal cancer by the enhancement of the functional reserve of the preserved portion of the larynx and the prevention of the narrowing of its lumen. Another objective was to develop an algorithm for the rehabilitation of the patients with laryngeal localization of the tumour following open functionally sparing operations that consists of the operative and postoperative stages. During the period from 2006 to 2014, a total of 71 patients underwent functionally sparing operations. 66 of them were operated for laryngeal cancer, 1 for thyroid cancer spreading over trachea and larynx, 3 for papillomatosis. Resection of the larynx in the vertical and horizontal planes was performed in 62 and 9 patients respectively. Vertical plane surgery included the following procedures: fronto-lateral resection of the larynx in 51 patients, extended fronto-lateral resection in 10, and combined resection in 1 patient. It is concluded that the systemic approach to the treatment of the patients with laryngeal cancer and the proposed algorithm for their rehabilitation made it possible to restore the laryngeal function in 68 of the 71 patients (95.8%).

[Analysis of the causes of cancer negligence and low survival in the patients with malignant neoplasms of ENT and oral cavity in the city of Moscow].

The objective of the present study was to elucidate the causes of late detection of malignant neoplasms of ENT and oral cavity and low survival of the patents with these tumours in Moscow. The secondary objective was to elaborate the organizational measures for reducing the level of negligence and mortality from these malignancies among the city population. It was shown that the main cause behind the negligence is the late application of the patients for the medical assistance. Next in importance are asymptomatic clinical course of the disease in the absence of the pathognomonic and early signs of malignant neoplasms, a combination of several pathologies, imperfection of medical knowledge, and the poor resolving power of the modern methods. It is emphasized that the lack of vigilance against cancer among the practicing health providers is one of the main causes of medical errors. A few ways to address the problem of negligence with respect to malignant neoplasms of ENT and oral cavity in Moscow are proposed.

[The role of multispiral computed tomography in combined diagnostics of laryngeal cancer for the choice of treatment strategy and extent of surgical intervention].

This paper summarizes experience with the treatment of 50 patients with laryngeal cancer at different clinical stages of the pathological process. All the patients underwent comprehensive medical examination. Advantages and disadvantages of each method were evaluated in terms of efficiency for the assessment of the extent of laryngeal tumour and identification of metastases followed by the choice of treatment strategy and extent of surgical intervention.

[Prophylactic medical examination of patients with head and neck tumours in Moscow--continuity of patients' care provided by oncologists and general practitioners].

The primary objective of prophylactic medical examination of oncological patients is reduction of mortality and improvement of the quality of life. Activities of the Department of Head and Neck Tumours of No 1 Oncological Clinical Dispensary are focused on dynamic follow-up of treated patients for early identification of continued tumour growth, diagnosis of relapses and metastases. Compliance with the schedule of control examination in the post-treatment period facilitates early identification of continued tumour growth, diagnosis of relapses and metastases. It is maintained that irregular examination is a cause of progression of latent relapses and metastasis in oncological patients. Actions and duties of district otorhinolaryngologists and ENT specialists of the Department of Head and Neck Tumours, No 1 Oncological Clinical Dispensary are outlined for the periods of prophylactic medical examination and follow up studies at the pre-hospital stage and in the course of dynamic post-treatment observations. Continuity of patients' care provided by oncologists and otorhinolaryngologists is supposed to contribute to the reduction of time spent during pre-treatment studies, early diagnosis of relapses and metastases, and improvement of the quality of life in the patients with incurable and recurring tumours.

[Criteria for multispiral X-ray computed tomography for the choice of extent of surgery on the tumour spreading outside the larynx].

The authors summarize the experience with the treatment of 38 patients with disseminated laryngeal tumours (stages III and IV). All the patients underwent comprehensive medical examination using a variety of methods. Their advantages and drawbacks are analysed with reference to diagnostic value, potential for the detection of metastases, and possibility to use for the choice of extent of surgical intervention. Criteria for multispiral X-ray computed tomography have been developed to be applied to the identification of tumour spread outside the larynx and invasion of its cartilaginous structures.

[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).

[Assessment of speech quality in patients with resected larynx].

The organ salving treatment of laryngeal neoplasms including their surgical resection at one of the stages was given to 25 patients. They were further followed up for the assessment of vocal function. Analysis of speech was performed by a group of 5 auditors. They counted how many times each patient heard a consonant as a sonant and vice versa. Based on the analysis of mistakes, the patients were divided into the following three groups: group 1 (many mistakes), group 2 (moderate number of mistakes), an group 3 (practically no mistakes). The most common mistake was devocalization of voiced sounds. Postoperative analysis of speech quality characteristics revealed their dependence on the extent of surgical intervention, the presence of tracheostoma, the type of plastic correction, and the dose of radiation therapy. It was shown that extensive and combined frontal-lateral resection leads to voice impairment. Tracheostoma also have negative effect on speech discrimination.

[Delayed results of the treatment of patients with laryngeal cancer in Moscow].

The objective of the present study was to analysis results of the follow-up survey involving 1,532 patients with laryngeal cancer residing in Moscow for the period from 1999 till 2005. The five-year survival rates among the patients treated in otolaringological departments of general medical care settings (12.6%) and in specialized oncological centers of Moscow (87.4%) were compared. The difference between the outcomes of the treatment are attributable to a variety of causes. It is emphasized that surgical treatment of patients with stage III and IV laryngeal cancer should be combined with radio- and chemotherapy. The treatment should be given in specialized oncological facilities having the adequately trained personnel and the necessary equipment for the in-depth examination of the patients to ensure planning rational treatment strategies and preventive medical surveillance on a permanent basis.

[New possibilities for the treatment of pharyngeal and tracheal stenoses following resection of an organ and laryngectomy in patients with disseminated laryngeal and laryngopharyngeal cancer].

Results of the treatment of 174 patients with stenosis of larynx and trachea by conservative, surgical, and endoscopic methods at different periods after operation indicate that application of novel endoscopic and physical techniques substantially extends possibilities for the low-invasive correction of postoperative laryngeal and tracheal stenoses.

[Analysis of late diagnosis of ENT cancer in Moscow].

Statistics on ENT cancer detection in Moscow say that in the last 3 years 70% patients with ENT cancer were first examined by the oncologist at advanced stage (III-IV) of the disease. Main objective and subjective causes of late diagnosis are analysed and measures to improve the situation with late ENT cancer diagnosis are proposed. Special attention is paid to the problem of cancer alertness of general practitioners.

[Minor surgery in laryngeal cancer].

The article presents the results of conservative surgery in 102 patients with laryngeal cancer T2 and T3. Frontolateral laryngeal resections in different variants (endoprosthesis, extended, an inferior variant) were conducted in 85 (83.3%) patients, horizontal laryngeal resection - in 17 (16.7%) patients (a combined variant -in 2 of them). The treatment resulted in primary healing of a postoperative wound in 92 (90.2%) patients. Complications consisted in development of pharyngeal fistula, suppuration of the postoperative wound, first of all in combined and extended resections, after a total dose of radiotherapy. Minor operations on the larynx enabled decannulation of 98 (96.1%) patients. Four (3.9%) patients continue to carry cannula because of marked scarry alterations.

[Clinical implications of laryngeal echosonography in cancer diagnosis].

Laryngeal echosonography was made in 50 healthy subjects and 186 patients with laryngeal cancer to evaluate efficacy of ultrasound in diagnosis of laryngeal cancer. The study revealed sonographic characteristics typical for laryngeal cancer, endophytic tumors, in particular. Ultrasound can assess involvement of the laryngeal cartilages and severity of their lesion, invasion of the tumor into the underlying tissues and cervical organs. The tumor can be verified by puncture aspiration biopsy using ultrasound monitor. All this allows more effective choice of an optimal treatment method and planning of the scope of surgical intervention.

[Risk factors of laryngeal cancer in Central and Eastern Europe].

A case-control epidemiologic study in squamous-cell carcinoma of the larynx (LC) vs. smoking was carried out. Although no independent influence of drinking was found, the synergetic effect of the two habits potentiated the carcinogenic impact. Approximately 87% of LC cases are attributable to tobacco use in Central and Eastern Europe. Occupational exposure to coal dust is regarded as a possible cause.

[Multispiral computed tomographic semiotics of laryngeal cancer].

Multispiral computed tomography (MSCT) with intravenous bolus contrasting is a currently available method for radiodiagnosis of laryngeal cancer. MSCT is of much higher informative value in estimating the extent of a tumorous lesion than the traditional radiodiagnostic techniques: linear tomography, lateral X-ray study, roentgenoscopy and roentgenography of the laryngopharynx and esophagus with barium meal.

[Malignant tumors involving the skull base: methods of treatment and results].

The paper presents experience with surgical and combined treatment of 197 patients with malignant tumors involving the skull base and extracranially originating. The authors have defined indications for and contraindications to different types of surgical treatment, developed methods for radical and palliative tumor removal, which are based on a comprehensive approach considering the basic principles of oncology and neurosurgery. Assessing the immediate and long-term results of surgical treatment by mathematical statistical methods could reveal the major factors influencing survival rates in patients after surgery and the duration of a relapse-free period.