In most developed industrialized countries of the world, lung cancer is the most
common form of malignant neoplasms in men. At present
time every twentieth man dies from this disease.
In many regions, including our country, there is a tendency to increase
morbidity and mortality rates from lung cancer. So, from 1970 to 1986
the incidence of lung cancer in men in the USSR increased from 35.6 to 63.3 0/0000 or
77.8%, in women from 8.1 to 11.8 o / 0000 or 45%. In 1987 in the USSR
107 thousand new cases of malignant population have been registered
neoplasms of the trachea, bronchi and lungs. It is expected that in the coming years there will be
there is a further increase in the incidence of lung cancer and absolute
the number of first-time cases in the former USSR by 2000 will be more than
130 thousand people.
Despite all the achievements of modern medicine still fails
achieve a qualitatively significant improvement in the results of treating cancer patients
lung. This is largely due to the fact that only a small proportion of patients (15%)
undergoes radical surgical treatment, which today
It is a priority and most likely to hope for a long
patient survival compared to conservative anti-tumor methods
therapy.
The majority of patients, up to 70%, go to hospitals in advanced
stages of the disease when the ability to perform radical surgery
become problematic, moreover, in 3.5—% of their number, local distribution
tumor process is characterized by lesions of various extrapulmonary
anatomical structures and organs of the chest cavity. Surgical treatment of this
patient category is one of the most difficult and least developed
problems of modern oncopulmonology.
In the clinic of thoracic (until 1991 — hospital) surgery of the Military
Medical Academy surgical treatment of patients with advanced stages
Lung cancer has been practiced since 1953. With the accumulation of experience, the development of technical
techniques and methods of surgical interventions, improving technical equipment
clinics, improving the organization of examination and treatment of patients,
their hospitalization at the clinic began to be carried out systematically. Since the beginning of the 60s
the problem of surgical treatment of patients with advanced stages of lung cancer
is one of the most important areas of research department.
To analyze the results and possibilities of surgical treatment of cancer patients
lung with a far advanced locally advanced tumor process,
characterized by lesions of various extrapulmonary anatomical structures
and organs of the thoracic cavity studied the work of the clinic in this direction from 1960 to
1996 inclusive.
The vast majority of lung cancer patients have been reported for treatment with
far advanced stages of the disease. So, among hospitalized to the clinic
Stage III was 75%. In-depth preoperative examination and, especially,
intraoperative diagnosis required a revision of the stage of tumor development in
I will increase it in 10% of patients.
Of the total number of lung cancer patients admitted to the clinic, there were
72% were operated on. At the same time, 88.9% managed to produce various resections.
lungs. The main types of surgical interventions performed in the clinic
lung cancer are advanced and advanced combined
resection. In the structure of surgical interventions, they add up to 68.2% in total.
More than a third of these operations (35.2%) accounted for the share
combined resections of the lungs. In relation to the total number of operational
interventions for lung cancer, extended combination
resections add up to 23.9%, and a significant increase was observed
in the general structure of surgical interventions from 18.6% in the first period of the clinic’s work to
28.2% in III, that is, in recent years, they have been produced for almost everyone.
the third patient.
Extended and extended combined resections were more often performed with
central lung cancer (75.8%), while almost equally often as with
right- and left-handed localization, respectively -57.5% and 42.5%.
The predominant form of the histological structure of the tumor was
squamous without keratinization lung cancer (47.8%). The share of various forms low
differentiated lung cancer accounted for 29.3%, moreover, it was more common in
young patients —38.6%, and among women — 36.4%. For women also
it turned out to be characteristic more frequent, compared with men, the presence of glandular
lung cancer, respectively -27.3% and 6.1%.
Characteristic features of the local distribution of blastomatous
process in operated patients had large primary tumor sizes in
lung and the presence of extensive lymphogenous metastasis. So, in 53.7% of all
Observations of tumor size at the time of surgery
was more than 5 cm in diameter. Lymphogenous metastases were detected in 85.5%
patients, in 64.6% of all cases with mediastinal lymphatic lesions
collectors. 0.8% of operated patients had metastatic lesion
lymph nodes of supraclavicular areas. Lymph metastasis
lymph nodes, as a rule, was widespread, with simultaneous
defeat of several groups of lymphatic collectors. Characteristic for almost
one third of patients (20.8%), was the merger of several groups of metastatic changes
lymph nodes and primary tumor in a massive tumor conglomerate,
widely ingrown into the mediastinum.
Tumor lesions of various extrapulmonary anatomical structures and
thoracic organs in 45.4% of patients were multiple. Of them
78.4% of two anatomical lesions were noted, in 18.6% – three and
3.0% is four.
Most often, in 60.1% of all cases, a pericardial lesion was observed,
requiring the completion of his resection, almost a third of patients (31.5%) had
Subtotal mediastinal pleurectomies with resections of fragments were performed.
nerve trunks mediastinum. The nature of blastomatous lesions of various
extrapulmonary formations and organs of the thoracic cavity substantially depended on
the location of the primary tumor site. So, when the tumor is located in the upper
the lobe of the right lung was significantly more likely than at other sites
superior vena cava, lateral wall of trachea, ribs. Pericardial disease and germination
a tumor of pulmonary veins with an auricle met much less often. For a tumor
the middle share of the characteristic and most frequent lesion was germination
pericardium. The defeat of the diaphragm occurred most frequently when located
tumors in the lower lobes and much less often in the middle lobe. At the same time, on the right
the incidence of diaphragm damage was significantly higher. Other characteristic
germination was a lesion for the right-sided lower lobe localization
tumors in the esophagus and through the pulmonary veins in the atria. Much less frequently in these cases, a lesion of the pulmonary artery was noted. When left-sided localization
tumors in the upper lobe more often observed pericardial damage, massive germination
tumors in the mediastinal pleura, in the vagus and phrenic nerves.
The lesion of the pulmonary artery was characteristic of this site. Germination
a tumor in the aorta was observed only with the defeat of the left lung,
equally often as with the localization of the tumor in the upper and lower lobes of the lung.
For patients with lung cancer with advanced stages of the disease
characteristic is the presence of various pathological disorders
functional status of the organism, developing as a result of age
changes and associated diseases, as well as complications of the course of tumor
process, usually associated with the development of paracancrosis inflammatory
changes. Concomitant diseases or disorders were detected in 80.2%, which
significantly increased their functional risk of surgical treatment. 59.2%
patients noted the presence of various severity paracancrosis inflammatory
changes in the affected lung and surrounding tissues: paracancrosis
pneumonia, lymphadenitis, purulent tracheobronchitis, pleurisy, abscesses in
disintegrating tumor. Adverse combination of effects on the body
the patient products of tumor metabolism and purulent paracancrosis
intoxication largely determines the severity of the developing functional
changes determines the clinical course of the disease. Wherein,
The protective and reparative capabilities of the patient are clearly reduced.
The success of surgical treatment depends largely on
the effectiveness of preoperative preparation. It is the treatment of common and local
manifestations of paracancrosis infection is its main content in such
the sick.
In the process of preoperative examination, confirmation of the diagnosis of the main
diseases in patients with advanced stages of lung cancer are usually not
causes great difficulty. In 95.6% of patients before surgery can produce
morphological verification of the tumor using cytological and
histological studies of material obtained by various methods
biopsy. Certain difficulties are presented by the definition before the cell operation.
tumor structures, especially in poorly differentiated lung cancer, that
due to the polymorphism of the structure of tumors, the presence of paracancrosis
inflammatory changes and, in part, deformation of the tissue in the process of obtaining
biopsy material. In 39.2% of patients with poorly differentiated forms
tumors showed a discrepancy between the results of histological examination
biopsy and surgical material. Therefore, the histological structure
a tumor established before surgery should not be the only criterion for
addressing the issues of treatment tactics.
The most difficult tasks of preoperative examination is
diagnosis of the local prevalence of the tumor process and its presence
generalization. To solve them and determine the indications for surgery for all patients
complex clinical x-ray and instrumental
examination. Its volume is determined by the nature of the pathological process and must
be individualized. In addition to the required research methods, such as
radiography and x-ray tomography of the chest cavity, bronchoscopy,
ultrasound examination of the abdominal cavity, according to indications are held
other methods of radiological and instrumental examinations. In their choice
it is necessary to consider not only the data of the preliminary examination of the patient,
clinical manifestations of the disease, but also features of the course and spread
various forms of lung cancer. One of the most informative and safe methods for diagnosing tumor metastases in the abdominal organs is
ultrasonography. In the presence of technical capabilities, it should
be screened for all lung cancer patients entering
hospital
Recognize signs of significant tumor spread, such as
a clear transition to the trachea, its bifurcation, the esophagus usually does not represent large
difficulties. More difficult is the assessment of indirect signs of tumor growth,
determination of the length of the process, the ability to perform surgical treatment.
Additional, often insurmountable at the stage of preoperative examination
difficulties in clarifying this issue are associated with the cancer process
inflammatory changes. Finalize the ability to perform
radical surgery, in some cases, is possible only after thoracotomy, in the process
thorough intraoperative diagnosis.
It is very important, determining all subsequent tactics of treatment in patients with
advanced lung cancer is the determination of the nature and prevalence
blastomatous changes after thoracotomy. At the same time, refined and deepened.
data obtained during the examination before the operation. Special responsibility for
determining the extent of the operation has clarification of the comparability of lung resection in
oncological reasonable volume with functional acceptability.
Intraoperative diagnosis is a difficult and sometimes traumatic stage
surgical intervention. It requires a lot of experience and high
operational skill. In the process of its implementation is required to complete or
partial separation of the lung from adhesions, dissection of the great vessels
chest cavity and mediastinal organs, often (in 57.4%) using
intrapericardial revision. To clarify the nature of the tumor lesion
atrial walls and vena cava can be used intracardiac
revision.
Transition of a tumor to various extrapulmonary anatomical structures and organs
chest cavity requires their resection. Determination of feasibility
surgical intervention and its radicalism can only be based on
accurate and reliable understanding of the prevalence of the blastomatous process.
Simple examination and palpation often do not provide complete information on all manifestations.
paracancosis inflammatory changes and the limits of tumor growth. Most
accurate information can be obtained by conducting urgent, if necessary
multiple histological studies. Only such an organization is operational.
interventions for lung cancer are consistent with the idea of ​​thoracotomy as
final and final stage of diagnosis. In the process of its implementation, along with
specifying the prevalence of the tumor process
development of inflammatory reactions in the tissues and formations of the chest cavity.
The difficulty of determining, prior to surgery, the local prevalence of lung cancer in
patients with advanced stages of the disease, as well as constant aspiration
to the expansion of indications for surgical treatment, it can be explained by the fact that
the number of trial thoracotomy in the clinic over time does not decrease and in
Overall, it is 11.1% of all surgical interventions performed about
lung cancer Trial thoracotomy in patients with advanced stages
tumor process is difficult and traumatic operative
intervention, accompanied by significant blood loss (about 0.75 l) and
relatively high postoperative mortality (9.2%). However, as shown
studies, it does not have a significant impact on
life expectancy of patients undergoing surgery and discharged from the clinic.
Considering the fact that in a number of cases, the final question of the possibility of performing surgical intervention can only be solved in the process of
intraoperative revision, it should be considered that the implementation of a test thoracotomy on
Today is a forced but quite justified method.
diagnosing the prevalence of lung cancer in advanced stages of the disease,
giving a chance to provide effective surgical care to the patient.
Extended combined resections — the most technically complex and
traumatic of all surgeries performed for cancer
lung. They require the surgeon theoretical knowledge and practical skills in
cardiovascular surgery, surgical gastroenterology, plastic
surgery. Each surgery is a non-standard operation that requires
individual approach, sometimes – unambiguous solutions. Performance
extended combined resections of the lungs is justified only in
specialized thoracic and oncological institutions. Operative
interventions undertaken about advanced stages of lung cancer with
lesion of extrapulmonary anatomical structures and organs of the chest cavity
require good technical equipment and the use of special techniques
operating.
We consider it fundamentally important that each
combined resection of the lung must necessarily include extensive removal
cellulose and lymphatic mediastinum, that is, to have the character extended.
Study of the characteristics of lymphogenous metastasis in extrapulmonary
the spread of the tumor proves the need for mediastinal
lymphadenectomy even in the absence of visible metastatic lesions
lymphatic collectors mediastinum.
At the heart of combined resections, as a rule, is extended
pneumonectomy, due to the nature and extent of local
the prevalence of the tumor process. Therefore, in the process of preparing and
planning an intervention it is necessary to assess the possibility
patient tolerance of such a volume of lung resection. Performing partial
combined resection of the lungs, with the hope of their radicalism, it seems
rarely, as a rule, in peripheral forms of lung cancer, in cases of limited
tumor lesions of one or another anatomical formation or organ
chest cavity and the absence of metastatic lymph nodes
mediastinum. In some cases, the indications for these operations are forced.
and are associated with low functional reserves of the patient and doubts about
portability them pneumonectomy. In the process of performing partial resections
lightweight often necessitates reconstructive and
plastic operations on the bronchi and pulmonary vessels.
When choosing the scope of surgery, the surgeon should evaluate not
only the prevalence of the tumor process, functional operability
the patient, but also the condition of the unaffected lung. Desire at any cost
reduce the volume of lung resection seems to us not reasonable, as with the point
view of oncological feasibility as well as remote functional
consequences of the operation.
Combined resections are performed in patients with advanced
stages of lung cancer, in which, as a rule, a number of common and local
disorders and disorders associated with tumor growth and its complications.
Intoxication of the body with products of the tumor organism, the development of paracancrosis
infections, damage to the lung and adjacent organs of a growing tumor, usually in
elderly people lead to profound dysfunction of the main systems
life support, all parts of homeostasis, inhibition of immunoreactivity and reparative abilities of the body.
Against this background, severe surgery, sometimes performed on the brink
technical capabilities and functional portability, creates a number of real
prerequisites for the development of dangerous local and general complications, as during
operations, and in the postoperative period.
The success of the surgical intervention depends largely on the organization
and well-coordinated work of all participants in the operation: surgeons, anesthetists,
transfusiologists, nursing staff. Full understanding and
consistency at all stages of surgery, accurate understanding of
the nature and mechanisms of the resulting functional disorders and
possible complications allows them to successfully overcome. The basis of this joint
of work is preventing the development of disorders and complications, and not fighting
already developed.
Highly traumatic combined surgery requires
especially respect for maintaining the body’s defenses, adequate
their protection from operating injury. The success of surgery is largely
determined by the organization of anesthetic management. For the past three
For decades, the principles and methods of anesthetic management of operations on
lungs have undergone significant changes. Many of them were laid in the walls.
clinics. The team of the clinic staff under the direction of
Professor Yu.N.Shanin developed a methodology for anesthesia and introduced into
The practice of a number of principles and methods that constitute today the basis
anesthetic management of thoracic surgery, including
and in patients with advanced stages of lung cancer.
Surgical pathology, surgery, anesthesia and related disorders
lead to the disintegration of the body as a functional system, which inevitably
increases its entropy. Therefore, the generalized task of anesthesia
is to give it a non-entropic properties that promote natural
compensatory processes. The solution to this problem is achieved reliable
anesthesia and prevention of hypoxia. Used in the clinic
Anesthesia, providing multi-level anesthesia
(combination of intravenous ketamine-fentanyl anesthesia, regional blockade and
local infiltration anesthesia), refusal of nitrous anesthesia, changing the content
oxygen in the respiratory mixture in accordance with the features of the stages of the operation and
patient’s needs provide the most effective protection
functional reserves and self-regulation mechanisms from operational stress.
Expanding the possibilities of surgical treatment of patients with advanced
the stages of lung cancer and its safety have been promoted by the introduction of
practice of anesthetic maintenance of high-frequency injection
ventilation of the lungs, various methods, including those developed in the clinic,
protect the tracheobronchial tree from aspiration of pathological discharge
time of operations.
An important factor in the safety of surgical interventions is constant
attention to the prevention of blood loss and its adequate replenishment. Operating room
blood loss and concomitant hypoxia in patients with advanced stages
lung cancer can negate all efforts to cure them. Therefore,
along with the improvement of operating techniques aimed at
prevention of blood loss, the clinic was very intensively carried out and carried out
scientific research to create the most adequate replenishment tactics
operating blood loss.
As a result of the development of strictly differentiated, pathogenetically substantiated indications for blood transfusions, studies on the preparation and
use of autologous blood transfusion media, justification
the expediency of using moderate hyper- and normovolemic hemodilution,
both during the operation and in the early postoperative period, it was possible
significantly reduce the need for homologous erythrocyte-containing media. So,
the use of combined transfusion programs combining various
options autohemotransfusions and reinfusion with prolonged normovolemic
hemodilution allowed to achieve effective replacement of blood loss volume
up to 25% bcc. Reasonable restriction of donated blood transfusions was considered
as a prerequisite for the prevention of postoperative processes
oxygen supply of the body.
Extended combined resections are the most traumatic and
dangerous of all types of surgery performed for cancer
lung. Disruption of the functioning of the main body systems in patients
those who underwent these interventions are much more severe than in patients after
simple, and even extended resections of the lungs. Extensive pericardial resections,
chest wall, esophagus, trachea, along with the removal of lymph nodes and
fiber mediastinum, “skeletization” of the mediastinum, significantly aggravated
the invasiveness of the intervention and fraught with a number of development possibilities
dangerous complications in the postoperative period.
Successful treatment of patients undergoing advanced combined resection
lungs, in the postoperative period is generally defined as rational
carrying out a complex of therapeutic measures aimed at intensive therapy
for the maintenance and correction of occurring dysfunctions of the most important systems
life support of the body, and effective local treatment, including
prevention, early diagnosis and treatment of complications in the area of ​​operation,
directly related to surgery.
Postoperative intensive care should be worn strictly.
individualized and comprehensive. Only mandatory conduct
the whole system of therapeutic measures, including prevention and treatment
violations of pulmonary gas exchange, normalization of the amount and composition of circulating
blood, treatment of microcirculation disorders, circulatory warning
hypodynamia, restoration of homeostasis can be achieved uncomplicated flow
postoperative period. Intensive observation, especially in the early and
nearest postoperative periods, allows you to clarify and specify
the effectiveness of therapy, in the early stages to recognize and treat
emerging complications. Extended combined resections, more often than others
pulmonary operations are accompanied by the development of severe postoperative
complications and lead to deaths. So, in the first period of the clinic
postoperative mortality reached 40%. Improving technology
surgical interventions, anesthesia, postoperative
intensive diagnostics and treatment allowed to reduce it to 25.5% in the II period
work, and in recent years up to 7.2%. In general, mortality after advanced and
extended combined resections in period III amounted to 6.1%. There were
contraindications to surgical interventions associated with
functional operability of patients. Postoperative reduction
mortality occurred mainly due to more effective therapy aimed
prevention of the development of complications, and, to a lesser extent, due to more successful
treatment of the complications themselves.
Significant changes have occurred in the structure and frequency of causes of death.
outcomes As before, cardiopulmonary failure remained the main cause of death in patients . Its share, as before, accounts for one third of all
deaths, although its frequency has decreased by more than half. Much
decreased incidence of severe postoperative pneumonia, leading to
lethal outcomes, but dramatically, the incidence of pulmonary thromboembolism increased.
Reduction in postoperative mortality occurred
mainly due to the improvement of therapeutic measures aimed at
prevention and treatment of cardiovascular and respiratory failure,
postoperative pneumonia. Significant increase in life expectancy
patients in the postoperative period from 3.1 days to 14.3 days significantly affected
on the frequency and structure of fatal complications. Simultaneously with the decline
death rates from cardiopulmonary failure and
postoperative pneumonia, the cases of severe
thromboembolic complications. Postoperative mortality significantly
depended on the nature and extent of damage to extrapulmonary structures and organs
chest cavity, and therefore, on the characteristics of the performed operative
interventions. In multiple resections, postoperative mortality was
higher than with solitary. The immediate results were less dependent on the type.
resections: among single resections, they were worse after resections
tracheobronchial type.
Improving the organization and maintenance of the system of therapeutic measures,
conducted by the patient during and after surgical interventions,
can significantly reduce the incidence of severe postoperative
complications and their resulting lethal outcomes and is significant
reserve to improve the overall results of surgical treatment of cancer patients
lung with advanced stages of the disease.
Evaluation of the effectiveness and feasibility of operational
interventions in lung cancer patients in advanced stages of the disease
carried out on the basis of studying the duration of their lives. At the same time, the main
the criteria for evaluating the remote results of operations were indicators of a five-year
survival rate.
In patients undergoing advanced surgery five-year
overall survival rate was 27.8%. Somewhat worse long-term results
were observed after extended combined resections of the lungs.
Monitoring the fate of patients who underwent surgery and
discharged from the clinic, as well as analysis of the data, allow us firmly
speak in favor of the fact that extrapulmonary spread of the tumor itself
itself is not a contraindication to surgical treatment. Extended
combined lung resections in these patients are most responsive
principles of oncological radicalism and allow for a five-year
survival rate of 21.7%. Performed by the patient with the most extensive
the spread of the blastomatous process, extended combined
pulmonary resections have a significantly worse prognosis than other types of surgical
interventions for lung cancer. However, the lack of
Today, the alternatives to the real help of this category of patients allows
consider their use justified and appropriate.
The most reasonable is the implementation of advanced combined
pulmonary resections in patients with stage III A disease, in which the results
five-year survival rates were the best (26.8%). Operative
interventions in patients with stage III should be considered conditionally
radical, even with the possibility of “complete” removal of all elements of the tumor.
Indications for the implementation of such surgical interventions should be made individually, taking into account all the characteristics of the blastomatous process. Remote
the results of surgical treatment of patients with stage III V are significantly worse, five and
over 8.2 years, only 8.2% of the patients who have undergone surgery have lived.
Advanced combined operations for stage IV lung cancer, of course,
are palliative. Long-term results and average duration
life in patients who have undergone such surgery, almost no
differ from analogous parameters in non-operated patients. Considering
high postoperative mortality, it is necessary to recognize these operations not only
meaningless, but also extremely dangerous. They should be performed only in
In exceptional cases, as a rule, for urgent indications. Remote
prognosis of surgical treatment of patients with advanced stages of lung cancer,
characterized by extrapulmonary tumor spread, depends on a number of
factors. The most important of these are: the nature and extent of lymphogenous
metastasis, histological form of lung cancer, the size of the primary tumor,
the nature and extent of lesions of extrapulmonary anatomical structures and
organs of the thoracic cavity.
The presence of tumor metastases in mediastinal lymphatic collectors
adversely affects the long-term results of surgical treatment
patients, however, should not be a contraindication to operative
intervention. Performing a wide mediastinal lymphadenectomy in combination
with combined resection of the lung allows in 18% of patients to achieve five years
survival after surgery. The question of the feasibility of operational
interventions in patients with lymphogenous metastases in supraclavicular
areas require further study. Based on the analysis of available clinical
Observations can only make the assumption that the extended
combined resections in combination with wide cervical lymphadenectomy may
be shown in patients with metastasis of lung cancer to the lymph nodes
supraclavicular region of the same side, in cases of high and
moderately differentiated tumors in patients with preserved
functional reserves of the body.
Differences in the histological structure of the tumor in high, moderate and
undifferentiated forms of squamous cell carcinoma and adenocarcinoma in far
advanced stages of lung cancer, according to the data obtained, do not have a significant
effects on long-term results of surgical treatment. Extrapulmonary
the spread of the tumor eliminates the recognized effect on the outcome of the disease
such a sign as the degree of differentiation of lung cancer. The exception is
only undifferentiated forms of the tumor cell structure, in which
five-year survival rates are significantly lower at 5.1%. Most
low rates were obtained in small cell carcinoma, in which not a single patient,
underwent surgery, did not survive two years, and their average life expectancy
practically did not differ from the average life expectancy of non-operated
the sick. Given the high risk of the operation and the resulting
unsatisfactory results, it can be assumed that with this histological
the form of the structure of the tumor, in patients with advanced stages of development
diseases, planned surgical treatment is not shown.
Adverse factor affecting long-term results
surgical treatment are large tumor sizes, 6 cm and more in
across, which may indirectly indicate how the duration of the flow
blastomatous process, and on the intensity of tumor growth. With such sizes
tumors are usually observed massive lymphogenous metastasis and
multiple lesions of extrapulmonary anatomical structures and organs of the chest cavity. Five-year survival for such “giant” tumors
amounted to only 10.2%. The data obtained allow to note clearly
traceable inverse relationship between the size of the primary tumor
node and long-term results of surgical treatment.
The prevalence of the tumor process are the nature and
sizes of tumor lesions of various extrapulmonary anatomical structures and
organs of the thoracic cavity. The presence of their multiple lesions suggests
neglect of the blastomatous process, its aggressiveness. As a rule, these
patients noted the presence of metastases in mediastinal lymph nodes and large
the size of the tumor. In the presence of lesions of several anatomical structures and
organs of the thoracic cavity were performed by multiple expanded combined
resection of the lungs. Indicators of five-year survival after such operations were
worse than after single resections and were respectively 18.1% and 23.8%.
The long-term results of surgical interventions also depended on the nature of
extrapulmonary tumor lesions, and hence the type of resection.
The worst results of five-year survival (8%) were obtained after resection
parietal-diaphragmatic type. It turned out that the worst forecast
noted in patients with tumor germination in the chest wall, especially when
defeat of the ribs.
The analysis showed the absence of significant, reliably expressed
effects on the long-term results of surgical treatment of factors such as
clinical and anatomical form of the tumor, side of the lesion, sex of patients, volume
resection of the lung, although there was a tendency to an increase in five-year
survival in women and patients after partial resections of the lungs.
Analysis of the results of surgical treatment in various age groups
showed that the worst five-year survival rates (10.8%) were
patients under the age of 45, despite their lower rates
postoperative mortality. The reasons for such unsatisfactory results
is the more frequent presence of undifferentiated in young patients
forms of lung cancer.
Due to the nature of the clinical material available, it does not appear
It is possible to express your own judgment in many aspects of a combination
radiation therapy in patients with advanced stages of lung cancer. Based
data from the study can only be stated that
postoperative gamma-therapy in the mode of usual fractionation does not render
significant effect on the separated results of advanced combined
resections of the lungs.
In conclusion, once again arguing about the possibility of surgical treatment of patients
lung cancer with advanced stages of the disease that have
extrapulmonary tumor spread, it is necessary to emphasize that the choice
treatment tactics and determination of indications for surgery in these patients should be
strictly individualized. At the same time, given the complexity and trauma
surgical treatment, it is necessary to evaluate together all the factors of the prognosis,
both functional and due to the development of blastomatous
process.