At The pressure of the lung or part thereof

By extended resections of the lungs, we mean the removal of the lung or its part with the obligatory wide removal of regional lymph nodes, including lymph nodes and mediastinal tissue. Selective removal of enlarged, suspicious of metastatic tumors, mediastinal lymph nodes, from our point of view, is not a reason to classify the operation as expanded.

To extended combined resections, we include a resection of the lung or its part (usually in the amount of at least a lobectomy) with a portion of adjacent organs and tissues with direct spread of tumors to them, with the obligatory wide removal of regional lymphatic collectors, including mediastinal ones. Some kind of operations should not include some technical methods that facilitate the radical operation (intrapericardial ligation of the vessels of the lung, intersection of an unpaired vein, etc.), as well as interventions during which resections of other anatomical structures and organs are performed with visual suspicion of germination tumor tissue, which was not further confirmed by morphological examination. From the concept of extended combined resections, we also exclude the removal of sections of blood vessels and bronchi affected by tumor tissue, followed by their plasty, located intrapulmonary. It is advisable to classify these operations as reconstructive vascular or bronchoplastic surgical interventions. At the same time, resection of the mouth of the main bronchus, tracheal wall or extrapulmonary sections of the pulmonary vessels, with their blastomatous lesion, we refer to combined operations, since in these cases there is a tumor spread outside the affected lung. The leading criterion for determining whether the performed surgical intervention belongs to combined lung resection can only be histological confirmation of extrapulmonary lesion. Such a methodological approach allows us to evaluate with immediate objectivity the immediate and long-term results of extended combined lung resections, which are affected both by the volume of surgical intervention and the prevalence of the tumor process. Among 1720 patients who underwent expanded and expanded combined lung resections in the 1960s, men predominated – 1569 people (91.2%), women – 151 (8.8%), which amounted to 10: 1.

Lung cancer is a disease mainly in the second half of a person’s life. The age of patients operated in the clinic was from 24 to 79 years and averaged 54.8 ± 0.45 years. The distribution of patients by age and gender is shown in table 2.

As follows from the above data, the majority of operated patients, 1145 (66.5%), were aged 46 to 60 years.

The timing of the onset of the development of the disease cannot be precisely determined due to its latent course for a more or less long time. Guided by the history and radiological examinations, the duration of the disease before surgery in 1190 (69.2%) of 1720 patients was recognized as not exceeding six months. In 298 cases (17.3%), this period ranged from seven to twelve months, and in the remaining 232 patients (13.5%), it exceeded a year ago. Although most of the operated patients were admitted to the clinic relatively early from the onset of the disease, not exceeding half a year, all of them had advanced stages of lung cancer. This circumstance indirectly indicates a particularly aggressive course of their tumor process.

The location of the tumor in the lung when performing extended combined resections is essential. The peculiarity of the topographic and anatomical relationships of various extrapulmonary formations with the tumor determines the possibility of their primary blastomatous lesion, and therefore the nature of the surgical intervention. Accurate knowledge of the location of the tumor allows the surgeon to plan ahead for diagnostic and therapeutic measures, taking into account the most likely variants of blastomatous lesions that are possible with this location.

Of 1720 operated patients, in 989 (57.5%) the tumor was located in the right lung, in 731 (42.5%) in the left. In the advanced stages of the disease, it is often difficult to accurately determine the localization of the initial site of the primary tumor lesion, especially when the tumor extends beyond the lung lobe, and with central cancer spreads to the main bronchus. However, the analysis of the data of x-ray, bronchological studies and, especially, a thorough study of the preparations of the removed lungs, with a high degree of certainty, suggest the localization of the primary focus. Most often, in 1030 (59.9%) patients, the tumor developed in the upper lobes of the lungs, in the lower lobes it was in 624 (36.3%) patients, and only 66 (3.8%) cases affected the middle lobe.

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