From the standpoint of modern oncology, the most important properties of a malignant tumor, which have a decisive influence on the course and outcome of the disease, are their ability for uncontrolled, relatively autonomous, infiltrating growth and metastasis, i.e. the transfer and transfer of tumor cells from the primary focus to practically any tissue of the body, where they can become the source for the development of new foci of tumor growth (Napalkov NP, 1989). It is these factors that determine the objectives of antitumor treatment – the desire for the complete removal or destruction of the primary focus within healthy tissue and the suppression of the possibility of the resumption of tumor growth caused by the dissemination of tumor cells. The most effective method of solving the first and, in part,The second task (for regional lymphogenous metastasis) is surgery.

The radicalism of surgical interventions in lung cancer is determined by their compliance with surgical formulated compliance with oncologic ablastics and antiblasty operations. Ablastics during surgery for lung cancer is achieved by adhering to a number of principles of the operation. Chief among them is the principle of zoning and capillary removal of the tumor. In accordance with it, special attention should be paid to careful removal of one block together with the affected lung or part of the regional lymphatic apparatus with the surrounding tissue and areas of the pulmonary extrapulmonary tumors. This should be carried out within healthy tissues and be carried out without compromising the integrity of the tumor and its metastases.

However, the technical difficulties of performing advanced combined resections at advanced stages of lung cancer do not allow in some cases to make the removal of areas of some extrapulmonary anatomical formations with one lung and lymphatic apparatus. This is especially true for large vascular trunks, such as the aorta, superior vena cava. Attempts to perform their resection in a narrow operating field, at great depth, without the use of techniques that ensure the safety of intervention (leading turnstiles, bypass surgery) often result in the development of severe, sometimes fatal complications. Therefore, we consider it permissible to perform such resections after the removal of the main surgical preparation in caseswhen there is a blastomatous lesion of the extrapulmonary formations and organs of the chest cavity due to their germination by separate tumor metastasis not related to the primary tumor site. Removal of the same tumor in parts, its main cancer treatment of malignant in 1958 and principles established for tumors. Most fully they provide for fragmentation, should be considered a palliative operation and justified only with the development of severe complications that directly threaten the life of the patient.

As applied to the surgical treatment of lung cancer, the notion of “shellness and zonality of surgical intervention” provides for the mandatory removal during surgery of not only the lymph nodes affected by metastases, but also the lymph nodes of the next stage that are not captured by the tumor process. Considering the peculiarity of lymphogenous metastasis in advanced stages of lung cancer, especially in cases of lesions of extrapulmonary tumors and organs of the thoracic cavity, a broad mediastinal lymphadenectomy, ie the implementation of extended surgical interventions. Therefore, from our point of view, an extended or advanced combined resection of the lung should be a standard operation for advanced stages of lung cancer.

This position is confirmed by studies conducted in the clinic. So, out of 605 operated patients in whom combined operations were performed, only 58 patients lacked lymphogenous metastases (9.6%), and 120 had affected interlobar lymph nodes and lung root (19.8%). In the overwhelming majority, 427 (70.6%) patients had metastases in mediastinal lymph nodes. Of these, only 73 patients (17.1%) had single metastases. Visual and palpatory control of the state of the lymph nodes is not a sufficiently reliable criterion for the absence of their tumor lesions. Of the 605 operated patients, in 135 (22.3%) there were no changes in the lymph nodes as suspicious for metastatic lesions. In the same time,as a thorough histological study of operating drugs allowed to exclude it only in 9.6%. An urgent histological examination of a lymph node suspicious for the presence of tumor metastases during the operation also cannot be a reliable guarantor of the absence of metastatic lesions of the mediastinal lymph collectors in general. as, it is carried out selectively and concerns research only of certain groups of lymph nodes. At the same time, the reverse results are also frequent, when the surgeon regards the damage to the lymph nodes as metastatic, and a histological examination determines nonspecific inflammatory manifestations. So, when analyzing the results of 81 urgent intraoperative biopsy of lymph nodes suspected of their tumor lesion, it was establishedthat metastasis of the tumor was detected only in 52 cases (64.2%). Thus, in lung cancer with tumor lesions of the extrapulmonary formations and organs of the thoracic cavity, lymphogenous metastasis develops in almost 90% of cases, and more than 70% of all patients are affected by mediastinal lymph nodes. Selective histological examination and, especially, examination and palpation do not guarantee accurate determination the prevalence of tumor lesions of lymphatic collectors.