[Rethoracotomy in thoracic surgery].

Technical progress of recent years allowed thoracic surgery to become a safer procedure. Experience of thoracic operations in our institution counts up to 14 962 cases (1963-2009 yy). Of them 223 (1.5%) patients had rethoracotomies on the reason of various operative complications. 112 patients had the intrapleural bleeding, 56 patients were reoperated on the reason of coagulated hemothorax, 57 patients demonstrated the bronchial stump insufficiency, and 11 were reoperated on other reasons. The frequency of rethoracotomy had decreased from 2.5 to 0.2%. The on-time rethoracotomy allows to save the patients' life and do not aggravate the overall result of the treatment.

[Surgery for lung cancer in elderly].

The growth of malignant tumors of lungs among elderly patients together with overall increase of people older then 70, aroused new problems in surgery and anesthesiology. Nowadays, modern medicine succeeded minimal postoperative mortality and lethality among such patients, 19,7 and 6,4%, respectively. 3 and 5-year survival among operated patients was 68 and 42%. Actually, overall lethality rate was determined mainly by relative and conquering diseases. Lobectomy should be considered a method of choice, although sublobar resection is appropriate by lung tumors of stages 1 and 2.

[Surgical treatment of bronchiolo-alveolar cancer].

Bronchioloalveolar cancer (BAC) belongs to a high- grade differentiated lung adenocarcinoma, localizes in peripheral parts of the lung and demonstrates an intraalveolar growth. 21 patients with BAC has been operated during the period of 1968-2008yy. It comprised 0,5% of the whole amount of patients operated on lung cancer. Diagnostics of BAC, especially its pneumonia-like form, is considered to be challenging and often belated. Though it was retrospectively proven, that BAC is characterized by a slow growth and rare involvement of lymph nodes. Lobectomy is considered to be a method of choice for the surgical treatment. Long-term treatment results are somewhat better then of other forms of non-small cell carcinoma of lung: of 21 radically operated patients, 11 are alive.

[Surgery of rare malignant lung tumours].

4023 operations on account of primary bronchopulmonary cancer were performed in the period of 1963--2006 years. Rare malignant tumors (carcinoid, adenocystic cancer, sarcoma, large cell carcinoma etc.) were diagnosed in 379 (9,1%) cases. 275 patients of those had bronchpulmonary carcinoid; adenocystic cancer was diagnosed in 26 patients; 67 had various types of non-epithelial malignant tumors and 11 had a large cell carcinoma. All patients were operated on, morphological verification was obtained in all cases. The surgical tactics in patients with rare malignant tumours should be the same as for non-small cell lung--lobectomy of pneumonectomy with lyphadenectomy. The long term follow-up results witness the advisability of surgical treatment.

[Diagnosis and treatment of lung cancer in polyneoplasia].

Recently there has been an increase in the incidence of polyneoplasias (PNP) of various organs. This is associated with certain advances in the treatment of malignancies with prolonged survival on the one hand and with better diagnosis and the emergence of new instrumental studies. The diagnosis and treatment of lung cancer as a component of PNP) currently remains a great challenge. In 1985 to 2004, the Acad. B. V. Petrovsky Russian Research Center of Surgery, Russian Academy of Medical Sciences, and Moscow Cancer Dispensary One treated 403 patients for lung cancer detected in combination with an extrapulmonary malignant tumor or second lung cancer, which amounted to 8.9% of the patients operated on for lung cancer. Primary malignancy of the lung and secondary neoplasm were synchronously and metachronously diagnosed in 165 (40.9%) and 238 (59.1%) patients, respectively. Lobectomy was performed in 207 (51.4%) patients while 79 (19.6%) patients underwent sublobar resection. Three- and 5-year overall survival was 43.4 and 30.6%, respectively. After radical operations, better 5-year survival rates were observed in patients with metachronous lung cancer in PNP (32.5% than in those with synchronously detected one (27.9%) (p < 0.05). The results depended on the stage of the disease--all patients with Stage IIIB died within the first year postoperatively. Thus, lung cancer as a component of PNP should be treated by the principles of bronchopulmonary cancer. Moreover, the similar long-term results that mainly depend on the stage of the disease are achieved. New instrumental studies establish the preoperative diagnosis in 88.4% of cases.

[Adenocystic bronchial cancer].

Among 4005 patients with lung cancer 26 (0.65%) of them had adenocystic bronchial cancer, including 13 male and 13 female patients aged 13 to 60 years. Overall 33 operations have been performed at 26 patients, 5 of them were operated twice, and 1 patient underwent 3 surgical procedures. The plastic operations on bronchi (10) were the main surgical procedures. Four patients underwent pneumonectomy with resection of tracheal bifurcation, and 2 patients - circular resection of primary bronchus with resection of carine and tracheobronchial angle. One patient died after surgery, postoperative complications were seen at 4 patients including hemothorax (1), bleeding (1) and empyema (2). Twenty-five patients have been discharged, 21 of them were followed-up. Three patients survived more 3 years, 6 patients - more 5 years, 8 - more 10 years, 2 - more 15 years, and 2 - more 20 years. Long-term results of radical surgical treatment argue the efficacy of these surgeries at adenocystic bronchial cancer.

[Long-term results of bronchial resection and plastic repair in patients with lung cancer].

Thoracic units perform plastic operations on the bronchi in 5-10% of all radical interventions for lung cancer. This figure was 7.5% at our unit. A total of 184 patients were operated on, with a mortality rate of 9.7% (18 patients died). Lobectomy with circulatory resection of the main bronchus is the optimal plastic operation on the bronchi in lung cancer. Long-term results following bronchial resection and plastic repair suggest the oncological rationale for these operations. These operations make it possible to preserve functionally significant lung tissue, thus assuring the high quality of life in the patient.

[Combined resections in the surgery of lung cancer]. / Kombinirovannye rezektsii v khirurgii raka legkogo.

Operations were performed on 3,313 patients for lung carcinoma in the Department of Surgery of the Lungs and Mediastinum of the National Research Center of Surgery, AMS USSR, from 1963 till 1.01.90. Among these patients 263 (7.9%) were treated by combined operations (resection of the lung together with part of the chest wall, trachea and its bifurcation, pericardium, diaphragm, superior vena cava, pulmonary artery, aorta, and atrium, and also with removal of metastatic lymph nodes of the contralateral lung). Three types of combined resections were carried out--vasculo-atrial, tracheo-bronchial, and parieto-diaphragmatic. Postoperative complications developed in 38.6% of patients. Intraoperative mortality was 1.5%, 13.9% of patients died after the operation. More than 5 years survived 21.8% of patients who underwent operation, more than 10 years 10.2%, and more than 15 years 5.6% of patients.

[Repeat uni- and bilateral operations in surgery for multiple primary cancer of the lungs and intrathoracic metastases]. / Povtornye odno- i dvustoronnie operatsii v khirurgii pervichno-mnozhestvennogo raka legkikh i vnutigrudnykh metastazov.

Repeated uni- and bilateral resections of the lungs conducted from 1963 to 01.01.91 at the Department of Surgery of the Lungs and Mediastinum of the National Research Center of Surgery, USSR AMS for primary multiple carcinoma (13 patients) and metastatic lesions (32 patients) accounted for 1.3% of all operations in lung carcinoma. Such interventions are more justified in differentiated forms of primary multiple carcinoma and in solitary and occasional metastases of malignant tumors of various localization to the lungs. Morphological signs are the main differential diagnostic criteria of primary multiple carcinoma and intrapulmonary metastases. The main principle of surgical treatment of patients with primary multiple carcinoma and metastatic involvement of the lungs is an economical character of the operation with maximally admissible, from the oncological standpoint, preservation of functionally valuable pulmonary tissue. The combined method of treatment (operation + drug antineoplastic therapy) should take the leading place in the management of patients with intrapulmonary metastases of malignant tumors.

[Surgical treatment of lung cancer extending into the thoracic wall]. / O khirurgicheskom lechenii raka legkogo, prorastaiushchego grudnuiu stenku.

In the Department of Surgery of Lungs and Mediastinum, National Research Centre of Surgery, USSR AMS, 88 patients underwent operation for lung carcinoma extending into the thoracic wall (which accounted for 2.6% of all patients who were operated on for carcinoma of the lungs) from 1963 to December 1990. Surgical treatment of such patients is the method of choice. The performance of both radical and palliative operations is expedient. The survival of patients after operation is determined by the depth of invasion of the thoracic wall by lung carcinoma and the condition of intrathoracic lymph nodes.

[Reoperation in primary malignant tumors of the lung operated earlier]. / Povtornye vmeshatel'stva pri pervichnykh zlokachestvennykh opukholiakh na ranee operirovannom legkom.

Retrospective analysis of 3,441 operations carried out in the Department of Pulmonary and Mediastinal Surgery, National Research Centre of Surgery, USSR Academy of Medical Sciences, from 1963 to 1990 for carcinoma and other malignant tumors of the lung showed that in 19 (0.6%) patients surgical interventions had been conducted on the same lung. Nonspecific pulmonary diseases, tuberculosis, and localized pneumosclerosis proved to be the most common diseases for which the first thoracotomy was performed. The number of such patients is continuously growing, in view of which the authors set them apart into an independent group of patients subjected to repeated operations in lung carcinoma. Approximately in half of these patients (47.4%) the malignant tumor occurred in the lung 8 years and more after the operation carried out for a benign disease; in the others (52.6%) the tumor existed in the lung at the first operation but was not removed due to diagnostic and tactical errors or was a latent carcinoma. It is concluded that timely and proper use of diagnostic methods and a high oncological alertness even during an operation for a benign disease may facilitate improvement of the results of surgical treatment of this category of patients with lung carcinoma.

[Economic operations in the surgical treatment of cancer of the lung]. / Ekonomnye operatsii v khirurgii raka legkogo.

Retrospective analysis of case records of 75 patients who were subjected to resection of a lung in a volume less than lobectomy showed that 2 types of economical operations are carried out today on patients with lung carcinoma: atypical resection and segmentectomy. According to the authors, such operations accounted for 2.4% of all lung resections for this disease. The main indication for radical resection of the lung in a volume less than lobectomy is stage I peripheral non-small-cell carcinoma (T1N0M0) in patients with serious concomitant diseases. Economical resection of the lung may be carried out in occasional cases with stage II of the disease (T2N0M0) and as a palliative measure. The late-term results provide evidence of the oncological expediency of economical operations in stage I peripheral carcinoma: for instance, 5- and 10-year survival of patients in such cases is 68.4 and 38.4%, respectively.

[Surgical treatment of stage I lung cancer]. / Khirurgiia raka legkogo I stadii.

From analysis of the results of operative treatment of 177 patients with Stage I lung carcinoma (T1N0M0) the authors came to the conclusion that among all the existing methods of antineoplastic treatment surgery is the most effective one in differentiated tumours. Lobectomy is the operation of choice in patients with Stage I lung carcinoma. Economic resection of the lung is expedient and justified in elderly patients with Stage I peripheral carcinoma and concomitant diseases. The late-term results are evidence that surgical treatment of stage I (T1N0M0) lung carcinoma is oncologically justified: 5-year survival of patients was 64.6% after lobectomy and 67.5% after economic resection.

[Surgical treatment of metastatic tumor of the lungs]. / Khirurgiia metastaticheskikh opukholei legkikh.

A total of 142 operations were carried out on 126 patients, aged from 8 to 73 years, for intrapulmonary metastases of malignant tumors of various localization. Marginal or wedge resection of the lung together with the metastasis was performed in 46 cases, the metastasis was removed by means of precision techniques in 14 and by enucleation in 10 cases. Lob/bilob/ectomy was conducted in 42 and pneumonectomy in 16 patients. The operations were of an obvious palliative character only in 3 cases. Three (2.4%) patients died after the operation. Among patients who were operated on for metastatic tumors of the lungs, total 3-year survival was encountered in 49.7%, 5-year survival in 36.9%, and 10-year survival in 30.6% of cases. The most favourable results were recorded in patients with solitary metastases. Survival of patients who underwent operation for a few and, particularly, for multiple metastases was poorer.

[Malignant nonepithelial tumors of the lung]. / Zlokachestvennye neépitelial'nye opukholi legkikh.

The main peculiarities of the clinical course of lung sarcoma were determined from representative material of 134 patients. The main features differentiating malignant nonepithelial tumors from carcinoma of the lung are: younger age (average age 45.5 years), predominantly peripheral clinico-anatomical form (82.8%), and prevalent hematogenic metastasis. Five-year survival in the whole group of patients after surgical treatment was 54%. The size and histological form of the tumor are the main factors of prognosis. The degree of differentiation acquires prognostic significance in tumors measuring more than 3 cm in diameter.

[Late results of the combined treatment of small-cell lung cancer]. / Otdalennye rezul'taty kombinirovannogo lecheniia melkokletochnogo raka legkogo.

The paper discusses an experience with combined treatment of 104 cases of small-cell lung cancer which included surgery. Small size of tumor matched by absence of regional and distant metastases was the major indication for surgery. All patients received chemoradiation treatment; 82 of them were followed up. Mean survival of operated patients was 35.5 months, and three-, five- and ten-year survival rates--36, 27 and 19%, respectively. Surgery appears to play a role in treatment of small-cell lung cancer, alongside with chemotherapy and radiation.