[Efficacious anesthesiological and resuscitation care--the cornerstone of modern oncosurgery].

A few modern concepts of anesthesiological and resuscitation care during complicated surgical interventions are considered with special reference to multimodal anesthesia as a principal tool for the protection of the patient from a surgical trauma based on the rational combination of three-component epidural analgesia (ropivacaine, fentanyl, and adrenalin) with sevoflurane inhalation narcosis and extention of the same epidural analgesia to the early postoperative period. The basic principles of infusion-transfusion therapy for the treatment of massive intraoperative blood loss ensuring its tolerability by the patient are discussed. Special attention is given to the problem of hospital-acquired infections and sepsis in oncosurgery. Methods are proposed for the improvement of the management of septic shock including immunomodulation, respiratory support, infusion and anti-infective therapies. It is concluded that the use of these conceptual approaches permits to perform extensive surgical interventions in patients with the initially low reserve capacity of vital functions.

[Resection and prosthetics of abdominal aorta by surgical treatment of invasive retroperitoneal tumors].

Data of 5 patients, who required resection and prosthetics of abdominal aorta during radical excision of malignant retroperitoneal lesions, were analyzed. Therefore, 2 patients demonstrated retroperitoneal lymph node metastases of nonseminoma hermonogenous tumour, 1 patient had colorectal liver and lymph node metastases, another had ovarian tumor, and the rest--leiomyosarcoma of the aorta. Tubular Gore-tex aortic prostheses were used. Radical tumor excision provided absence of local recurrence in all patients. Only one patient showed further progression of the tumor as liver metastases. Thus, such an aggressive surgical approach could be appropriate in carefully selected group of patients.

[Possibilities of immune prevention of pyo-septic complications in cancer patients by granulocytic colony stimulating factors]. / Vozmozhnosti immunoprofilaktiki gnoino-septicheskikh oslozhnenii u onkokhirurgicheskikh bol'nykh s pomoshch'iu granulotsitarnogo koloniestimuliruiushchego faktora.

The study was carried out during the postoperative period in 75 patients with cancer of the esophagus and cardial portion of the stomach and 40 patients with lung cancer; 64 of these patients received immunoprophylactic treatment with neipogen, granulocytic colony-stimulating factor. Immune prevention resulted in a 2-fold decrease in the incidence and severity of pyoseptic and visceral complications and 1.5 times decrease in the duration of hospital treatment and mortality during the early postoperative period. Neipogen therapy was conductive to a 2-fold increase in the leukocyte count during the postoperative period in comparison with the control. The range of "safe" values of the major mediators of inflammations (TNF-alpha, IL-1, IL-8), characteristic of uneventful course of the postoperative period, was determined. About 75% pyoseptic complications were associated with mediator levels below this range. The levels of inflammation mediators in the patients treated with neipogen were within the safe range.

[Problems and advances in anesthesiology and intensive care in oncologic surgery]. / Problemy i dostizheniia anesteziologii i reanimatologii v onkokhirurgii.

Numerous problems are to be solved by anesthesiology and reanimatology in modern oncosurgery: to protect weak exhausted patients from severe and extremely severe surgical injury, to carry out rational infusion/transfusion therapy and intensive care in massive blood loss, perioperative organ and polyorgan failure, and sepsis. Combined analgesia is used in highly traumatic oncological operations: inhalation narcosis with fluorine drugs with epidural analgesia and anesthesia. Good results were obtained in the treatment of very grave patients. Mortality from highly traumatic operations with blood loss higher than 50% of total circulating blood decreased to 10%. Modern methods of intensive care, such as intraoperative reinfusion of autoerythrocytes, extracorporeal detoxication, immunocorrection for preventing and treating sepsis, etc., are widely used with good effect.