[The assesment of significance of the retroperitoneal lymph node dissection in proximity of metastatic tumor with main vessels in patients with germ cell testicular tumors].

The therapeutic approach should be defined more exactly in proximity of residual retroperitoneal metastases of germ cell testicular tumor and main vessels (left after chemotherapy). The data of 29 (24%) patients were analyzed over a period of time since 2003 till 2011. The general survival was 82% in the group without lymph node dissection (17 patients) in median observation of 27.5 months. The proximity with main vessels was registered in half of the cases in the group of operated patients (12 people), a single vascular reconstruction was required. The general survival was 97% in median observation for 35 months. The involvement of main vessels of retroperitoneal space significantly complicated the retroperitoneal lymph node dissection, but didn't have negative prognostic value.

[Resection of leiomyosarcoma of the inferior vena cava].

Experience in treatment of leiomyosarcoma of the retrohepatic segment of the inferior vena cava at any separately taken clinic is scarce. Given a rare nature of the pathology involved, whose diagnosis and management require joint participation of various-specialty physicians, we have considered it wise to present our own clinical case report.

[Surgical treatment of leiomyosarcoma of the inferior vena cava].

The presented review of the literature is generalization of the currently existing data of foreign and Russian literature concerning treatment of a rare non-organic retroperitoneal tumour from smooth-muscle tissue, i. e., leiomyosarcoma of the inferior vena cava. The authors also formulate and lay down the basic principles of surgical interventions depending on the scope and level of the lesion, as well statistical analysis of the outcomes of surgical management of the this severely ill patient cohort.

Technical peculiarities of surgical management for renal cell carcinoma complicated by thrombosis of the renal vein and inferior vena cava.

The capability of renal cell carcinoma for dissemination resulting in formation of a tumour thrombus in the renal vein and inferior vena cava is regarded as one of its clinical peculiarities. At the Departments of the Chelyabinsk Regional Clinical Oncological Dispensary over the period between early 2002 and January 2008 we primarily treated a total of nine hundred and forty-four 43-to-76-year-old (mean age 59.1 years) patients for renal cell carcinoma. Of these, there were 550 (58.3%) men and 394 (41.7%) women. Tumour vascular invasion according to the preoperative examination was detected in 106 (11.2%) patients. Of these, a renal vein involvement was revealed in fifty-three subjects, the involvement of the inferior vena cava (IVC) below the diaphragmatic level in forty, and at the level of the diaphragm and above (IVC ostium) in eleven subjects. A total of eighty-two patients were operated on. Two patients died intraoperatively and a further three patients died in the early postoperative period (up to 3 days). Deaths were caused by pulmonary thromboembolism during surgery in one case and intraoperative blood loss followed by the development of the DIVC syndrome in the remaining cases. The mortality rate thus amounted to 6.1%, with the one- and five-year survival rates equalling 90.0% and 54.1%, respectively. The authors believe that the algorithm of examining the patients presenting with renal cell carcinoma should routinely include methods to diagnose potential thrombotic complications. Once a thrombus is detected, the plan of further examination and appropriate management is to be decided upon with due participation of the vascular surgeon. All preventive measures taken, nephrectomy with thrombectomy from the IVC is associated with low lethality and complication rates.

[Methods of medical and surgical correction of atherosclerotic aorto-arterial pathology in management of malignant neoplasms].

The article deals with 6 -year experience of the Centre of Oncoangiosurgery of the Chelyabinsk Regional Oncological Dispensary in treatment of patients with concomitant malignant neoplasms and atherosclerotic lesions to the aorta and arteries. The authors analyze therapeutic outcomes in a total of 158 patients. Of these, 81 patients were subjected to surgical correction of the blood flow. The presence of a clinically significant atherosclerotic lesion of the aorta and peripheral arteries in a patient should not be interpreted as an absolute or relative contraindication to contraindication combined treatment of the tumour concerned. In the majority of cases, atherosclerotic occlusion of femoral and tibial arteries was treated conservatively, using <>. In manifestation of an atherosclerotic lesion to the carotid arteries, aorta and iliac arteries, surgical correction of the blood flow was used more often. Usually, vascular reconstruction was carried out first. Simultaneous interventions were performed in 16 patients; three patients died. The technique of operations on the aorta and arteries was traditional, while for revascularization in peripheral lesions to the arteries of the limbs more frequently compromising methods were used (sympathectomy, profundoplasty, local endarterectomy) on the background of prostaglandin E1 infusions.

[Arteropathy as late-onset complication of radiotherapy for malignant tumor].

Such late-onset complications of radiotherapy as stenosis and occlusion of major arteries within fields of irradiation, designated in this paper as "post-radiation arteropathy", have not received sufficient scrutiny. The study group of 50 patients (1964-2003) included 35 females and 15 males, aged 33-77, (mean age--59 years). Total focal dose ranged 24-74.8 Gy (mean dose--48.9 Gy) per vascular bunch projection. Signs of ischemia were detected in the catchment area of irradiated artery after 8-360 months (average 90.6 months). Palliative treatment was given to 29 patients while 21 were operated on. Certain morphological features atypical of atherosclerosis were identified. Despite some negative factors, the results were not inferior to those of therapy for atherosclerosis. The hazard of stenotic effect of irradiation of major arteries in area of exposure should be perfectly clear to radiologists, oncologists and vascular surgeons.

[Therapy of cancer patients with concurrent critical atherosclerosis of the aorta and peripheral arteries]. / Lechenie bol'nykh so zlokachestvennymi novoobrazovaniiami i ateroskleroticheskoi patologiei aorty i perifericheskikh arterii.

The results are presented of 5-year experience with therapy of concurrent neoplasia and atherosclerotic lesions of the aorta and peripheral arteries gained at the Center for Oncosurgery, Regional Oncological Dispensary, Chelyabinsk. The analysis was concerned with the treatment received by 118 patients, irrespective of tumor stage or localization: surgical correction of blood flow was carried out in 60. Clinically significant atherosclerotic lesions of the aorta and peripheral arteries in a cancer patient should not be regarded as absolute or relative contraindication for combined treatment. Atherosclerotic occlusion of the femoral or shin arteries was managed conservatively in most cases (p<0.05). In cases of similar lesions of the carotid arteries and aortal aneurysm, surgical correction of blood flow was mostly used.