Enhanced combined resections for lung cancer — non-standard operations, including in this concept a number of different in character, size, and technique for performing operative techniques. The existing classifications, in our opinion, do not cover the whole variety of these surgical interventions and do not take into account the qualitative differences between single and multiple resections.

Along with the release of the majority of the authors of the three types resections extrapulmonary anatomical structures and organs of the thoracic cavity -sosudisto-atrial, tracheobronchial and diaphragmatic-parietal, we separately consider the so-called esophageal mediastinal-group combined resection of the lungs, including a subtotal resection extensive mediastinal pleura, large nerve trunks of the mediastinum, esophagus. The combination of such resections into the parietal-diaphragmatic group, along with resection of the diaphragm, chest wall, as some authors do, does not correspond to the essence of these surgical interventions, as well as the distribution of existing tumor lesions of extrapulmonary anatomical structures, features of the postoperative period.

The classification of advanced combined resections of the lungs, depending on the types of resections of various extrapulmonary lesions and the organ of the chest cavity, is presented .

An analysis of remote and, especially, immediate results of extended combined resections for advanced stages of lung cancer showed significant differences depending not only on the nature of extrapulmonary tumor spread, i.e. lesions of those or other extrapulmonary anatomical structures, but also on the prevalence of these lesions, the presence of various combinations thereof. 
 In 605 patients operated on in the clinic, 970 tumor lesions of various extrapulmonary anatomical structures and organs of the chest cavity were revealed. In almost half of the patients, 277 (45.8%), these lesions were multiple. Of these, 217 patients (78.4%) had a lesion of two different anatomical structures, 52 (18.8%) had three, and 8 (2.8%) had four. Moreover, from among patients with multiple extrapulmonary tumor lesions in 83 patients (30%), they predetermined the need for resections within one of the selected groups (vascular-atrial, tracheobronchial, mediastin-esophageal or parietal-diaphragmatic type), and in 194 ( 70%) required a complex surgical intervention combining resection of extrapulmonary anatomical structures of various types.

Based on the analysis of the experience of surgical interventions performed in the clinic, we identified single and multiple advanced combined resections of the lungs. We refer to operations in which multiple or more extrapulmonary tumors are resected to multiple resections. We refer to multiple resections of the same type as simple multiple ones, and combinations of various types of resections — to multiple combined (for example, a combination of vascular-atrial and tracheobronchial resections, etc.).

This approach, from our point of view, is justified, since it makes it possible to judge not only the vastness of extrapulmonary tumor spread, but also reflects the characteristics and invasiveness of surgery, allows a more differentiated approach to assessing the immediate and long-term results of surgical treatment of patients with advanced stages of lung cancer.