For more than forty years now, the problem of surgical treatment of lung cancer has been developed in the clinic of hospital surgery of the Military Medical Academy. Over the years, over three thousand surgical interventions have been performed. The main positions of the clinic in many areas of this complex and relevant problem for modern oncology are determined. The range of scientific research is quite wide and includes many issues of preparation, provision and implementation of surgical interventions for patients with lung cancer. Along with the development of surgical techniques and surgical tactics, a search is under way for improving the diagnosis of lung cancer, anesthesiology and intensive care, and the pathophysiological and morphological changes that develop in the patient’s body in connection with the disease and surgical intervention are being studied.
The problem of surgical treatment of patients with lung cancer with advanced stages of the disease all these years has been an important area of clinical research. The desire to provide effective surgical care to this numerous and most severe category of patients is explained not only by their not decreasing number in the general structure of the incidence of lung cancer, but also by the absence of other, sufficiently effective treatment methods that allow us to hope for long-term patient survival.
At the beginning of the 60s, with metastatic lesions of the lymph nodes of the mediastinum, the clinic performed advanced lung resections according to the method developed by I.S. Kolesnikov. Since the 70s, the problem of extended combined resections (combined operations) has been developed in patients with lung cancer with damage to extrapulmonary formations and organs of the chest cavity. In the event of experience accumulation, indications for certain operations were specified, the technique of surgical interventions was improved, and their immediate and long-term outcomes were studied.
An analysis of the results of treatment of patients with stage III lung cancer who underwent extended and expanded combined resections in the period 1960— showed that more than 26% of them live over 5 years. The justification and feasibility of surgical treatment of patients with advanced stages of locally advanced lung cancer has been proven. At the same time, high rates of postoperative complications and mortality dictated the need to improve the applied, development and implementation of new methods of diagnosis and treatment of patients with lung cancer at all stages of their stay in the clinic.
An important area of scientific research and practical work of the clinic was the problem of surgical treatment of patients with extrapulmonary tumor spread. It was found that the spread of blastomatous changes to extrapulmonary formations and organs of the chest cavity is one of the important factors determining the prognosis of surgical treatment of patients with lung cancer. The initial period of operation of the clinic, with a total mortality rate of patients who underwent extended and expanded combined lung resections, was 22.18%, mortality after extended combined resections reached 41%. The trauma and complexity of surgical interventions, the variety of postoperative complications caused by both resection of the tumor affected by the tumor, and extrapulmonary anatomical formations, required the development of special additional diagnostic methods, preoperative preparation, surgical techniques and postoperative treatment, as well as a different level of technical equipment of the surgical clinic. Analysis and generalization of the experience of surgical treatment of lung cancer patients who underwent extended and expanded combined resections in the clinic formed the basis of the work offered to the reader.