Position of the primary tumor node

The nature of the blastomatous lesion of various extrapulmonary formations and organs of the chest cavity significantly depends on the location of the primary tumor node. So, with tumor localization in the upper lobe of the right lung much more often than with other localizations, the superior vena cava, lateral wall of the trachea, ribs are involved in the blastomatous process. For tumors of the middle lobe, the characteristic and most frequent lesion is the germination of the pericardium. Damage to the diaphragm occurs mainly when the tumor is located in the lower lobes, and much less often in the middle lobe. Moreover, on the right, the frequency of damage to the diaphragm is much higher. Other lesions that are characteristic of right-sided lower lobe localization may be tumor invasion into the esophagus and along the pulmonary veins to the atrium.

With left-sided localization of the tumor in the upper lobe of the lung, pericardial damage, massive tumor invasion into the mediastinal pleura, vagus and phrenic nerves are much more often observed . Characteristic of this localization is damage to the pulmonary artery. Tumor germination in the aorta is observed exclusively with damage to the left lung. At the same time, it is equally often found both in the localization of a tumor in the upper and lower lung lobes.

In 275 out of 605 patients (45.4%) who underwent combined operations, tumor lesions were multiple, i.e. two or more lesions of various extrapulmonary formations and organs of the chest cavity were observed in one patient.

An integrating indicator of the prevalence of the blastomatous process is the distribution of patients according to the stages of the development of the disease. The stage of the disease depends on the size and prevalence of the primary tumor, its relationship to surrounding organs and tissues, as well as metastasis — localization and the number of metastases. The classification of lung cancer by stages, with a certain conditionality and schematic, allows us to evaluate the effectiveness of organizational measures to identify this disease, to ensure the exchange of information on the results of treatment with various methods.

The distribution of the operated patients by the stages of lung cancer development is brought into line with the recommendations of the fourth edition of the classification of malignant tumors according to the TNM system of the International Anti-Cancer Union. The transition to a new clinical classification of lung cancer TNM required a review of the stages of development of the disease in each of the operated patients. Moreover, the prevalence of lung cancer, as before, was regarded as a far-reaching stage of the disease, i.e. corresponding to stages III and IV of the development of the tumor process. The main changes affected the isolation of patients with stage III B and stage IV disease, since the main criterion characterizing stage IV lung cancer now is the presence of distant hematogenous metastases (M 1 ). The distribution of 1720 operated patients according to the stages of the development of the disease, in accordance with the classification of lung cancer according to the TMN system of the fourth edition.

The main criterion for judging the effectiveness of extended combined lung resections was the study of life expectancy. At the same time, it was assumed that the five-year survival rate was recognized as scientifically sound in assessing the results of treatment of cancer patients. During the five-year period after the operation, the fate of all patients operated in the clinic in the I and II periods of work and all 298 patients who underwent extended and expanded combined lung resections in 1987 — was traced. This made it possible to use the direct method for calculating the five-year survival rate.

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