[Surgical interventions with tracheal bifurcation circular resection in bronchial cancer treatment]. / Khirurgicheskie vmeshatel'stva s tsirkulyarnoi rezektsiei bifurkatsii trakhei pri lechenii bol'nykh so zlokachestvennymi novoobrazovaniyami bronkhov.

AIM: To evaluate results of circular resection and carina reconstruction in patients with bronchial cancer. MATERIAL AND METHODS: Study included 82 patients with bronchial malignant tumors operated for the period from 1998 to 2014. Mean age was 56±1.1 years (range 24-75). There were 75 men and 7 women. Squamous cell carcinoma, adenocarcinoma, dimorphic cancer, carcinoid, adenocystic cancer, small cell cancer and clear cell renal cancer were observed in 66, 9, 1, 3, 1, 1 and 1 patients respectively. Stages IIB, IIIA, IIIB and IV were determined in 5 (6.2%), 45 (56.3%), 28 (35%) and 2 (2.5%) patients respectively. Tracheal carina resection was combined with right-sided pneumonectomy in 62 (75.6%) patients, left-sided pneumonectomy - in 5 (6.1%) cases, right upper lobectomy - in 10 (12.2%) cases. 3 patients underwent carina resection alone. Plasty with bronchopulmonary segment of right upper lobe was applied in 2 cases. Since 2002 primary bronhomyoplasty using m.latiss.dorsi, m.intercostalis and m.serr.anterior flaps has been used in 64 patients. RESULTS: Postoperative complications occurred in 31.7% (26) of patients. In-hospital mortality was 10.1%. Use of primary bronhomyoplasty and head adduction reduced broncho-pleural fistula incidence and mortality (p<0.05). Long-term results in T3-T4N0 tumors were significantly better compared with T3-4N1-2 tumors (5-year survival 41.2 vs. 16.8%, p<0,05). CONCLUSION: Results of resection with carina reconstruction may be improved using primary bronhomyoplasty and is associated with satisfactory long-term results in patients with N0-tumors.

[Current problems in the combined therapy of lung cancer].

The paper describes the general experience of modern lung cancer treatment methods application. Neoadjuvant therapy was shown to improve the long-term results of stage III patients increasing the 5-year overall survival by 7,8% (p=0,012). The special diagnostic algorithm for treatment results evaluation including autofluorescence spectrometry with 97,1% sensitivity and 88,3% specificity was developed. The adjuvant external-beam radiotherapy in patients with mediastinal lymph nodes metastases was shown to increase the 5-year overall survival (14,7% versus 19,7%) (p=0,01). The combination of endotracheobronchial surgery with chemoradiotherapy allowed to increase the median survival time of patients with inoperable lung cancer to 17 months. Isolated lung chemoperfusion was shown to increase the overall (p=0,019) and relapse-free (p=0,005) survival in patients with lung metastases.

[Rationale for surgical treatment of cancer of the lower pulmonary lobe with consideration for regional metastatic spread]. / Obosnovanie taktiki khirurgicheskogo lecheniia raka lëgkogo nizhnedolevoi lokalizatsii s uchëtom osobennostei regionarnogo metastazirovaniia.

Optimal extent of surgery for lung cancer is determined to a great degree by lymph drainage and regional metastases vis-a-vis tumor localization in the lobes. Data on surgical treatment of 505 cases of cancer of the lower lobe are presented. The study established such peculiarities of metastatic spread to mediastinal lymph collector as relatively frequent involvement of the lower mediastinal lymph nodes ("jumping" metastases included) and greater likelihood of spread to the superior mediastinal lymph nodes when those of radix pulmonis are involved. The latter should be interpreted as an indicator of lower lobe involvement. We established the significance of relatively worse prognosis for mediastinal lymph node involvement as well as high frequency of intrasternal recurrences of tumors located in the left lung. The prevailing evidence on partial resections of the right lung rather than lower bilobectomy and the good results of bilobectomies for stage T1-3N1-2 tumors suggest that conservative treatment might offer more advantage in managing cancer of the lower lobe of the right lung. Extended surgery entails lower incidence of intrasternal recurrence and is more effective when used to treat right-lung tumors.