During surgical interventions on the lungs, several well-developed surgical approaches to the chest cavity organs are used: anterior-lateral (anterior) —in the patient’s position on the back, lateral — in the healthy side and posterior-lateral (posterior) —in the position on the abdomen.

The method of operative access in lung cancer is mainly determined by the features of the planned surgical intervention and the prevalence of pathological changes. With extended resections of the lung for cancer, the most difficult and crucial part of the operation is the removal of the regional lymphatic system, including its departments located in the mediastinum. The safety and availability of advanced surgical intervention, its radicalism largely depend on the convenience, reliable visual control of all surgical actions taken within the mediastinum, this is difficult in the topographic-anatomical and physiological areas of the chest cavity. The conditions are much more complicated with operations performed in patients with advanced stages of the disease.

For many years, the development of this problem in the clinic approaches and attitudes towards the selection and evaluation of various surgical approaches used in advanced lung resections have undergone some changes. For the first time years of work, anterior-lateral thoracotomy was given priority. At that time, this access seemed to be the safest for the patient from the point of view of both the anesthetic management and the surgical intervention. The main type of surgical intervention for lung cancer was then

removing the entire lung — performing extended pneumonectomy. Detailed clinical and morphological studies have clarified the indications, scope and features of performing a mediastinotomy with a wide lymphadenectomy. By the mid-60s, advanced pneumonectomy for lung cancer has taken its place in the surgical treatment of this disease. In those years, in our clinic, as in a number of leading thoracic hospitals and institutions in the country, they shared the position about the need to carry out a wide removal of lymph nodes and tissue of the medication during cancer, guided by a peculiar rule. It consisted in the fact that in lung cancer in all cases it is necessary to undertake pneumonectomy, since only such a volume of resection provides the possibility of widespread removal of the regional lymphatic apparatus of the lung in the mediastinum with obvious,and potential metastases. This ensures oncological radicalism of the surgical intervention.

Further development of the problem, the desire to preserve the sections of the lung not affected by the blastomatous process, without reducing the boundaries of mediastinal lymphadenectomy and not compromising oncological principles, led to a revision of operative access. Performing extended lobar resections of the lung ensured the admissibility of surgical treatment to a larger number of patients with lung cancer mainly at the expense of the older age group, as well as with reduced functional and reserve capabilities of the body. In many ways, this problem was successfully solved together with the formation and subsequent development of anesthesiology and resuscitation, the introduction of new techniques into the surgical practice, including the reconstruction and plastics of the bronchi.