Postoperative mortality is one of the main indicators
immediate results of surgical treatment of lung cancer.
Improvement of surgical techniques, achievements of modern
Anaesthesiology and resuscitation allowed in recent years to significantly expand
indications for surgical treatment of lung cancer and, at the same time, reduce the rates
postoperative mortality. In general, during lung surgery for cancer,
to the consolidated data of a number of authors, it ranges from 2.1% to 28.1% (Barchuk A.S., 1984; Bogdan T.T., 1984; Wagner R.I. et al., 1983; Davydov M.I. et al., 1989; Dyskin
V.P., 1971; Eftodiy V.V., 1987; Kolesnikov I.S. et al., 1975; Kotlyarov EV, 1983;
Kutushev F.Kh. and Libov, AS, 1983).

Postoperative mortality is still significantly higher in the late stages.
diseases due to the increased volume and severity of the operation. Special
the immediate results of the surgical procedure remain unsatisfactory.
treatment of lung cancer in extrapulmonary tumor spread. After
extended combined resections of the lungs frequency postoperative
complications, according to various authors, varies from 27% to 70%, and mortality
reaches 40% and more. (Biryukov, Yu.V. et al., 1985, 1992; Gagua, R.O. and Kuchava, V.O.,
1990; Glagolev A., 1975; Dobrovolsky S.R. and Grigorieva S.P., 1992; Zharkov V.V.,
1990; Zharkov V.V. et al., 1990, 1991; Kolesnikov I.S. and Shalaev, SA, 1982).
Of the 1720 patients with lung cancer, who in the clinic for the period 1960—2016.
extended and extended combined operations were performed
1473, 247 patients died. The overall mortality rate, therefore, was 14.4%.
However, when analyzing the frequency of deaths by periods of the clinic
it turned out that it has significant differences. So, in the first period of work
the clinic was equal to 22.18%, in the second –16.1%, and in the third –6.6%. After extended
resection of the lung general mortality by periods of work was, respectively
12.7%, 10.4%, 5.9%, and after expanded combined —41.0%, 26.3% and 8.0%.
For comparison, we note that the overall mortality in the clinic after simple resections
lung about cancer in 1987— accounted for only 2.3%.
Thus, in the last decade of the clinic’s work,
significant tendency to reduce mortality after surgery
about lung cancer in advanced stages of the disease (p <0.01). Concerning
we consider the immediate results of operations separately by period
clinic work.

In the process of performing extended and expanded combined resections
14 patients died in the lungs (0.8%). In the first period of work 6 patients (1.1%), during
the second — 4 (0.8%) and in the third — 4 (0.6%). Intraoperative mortality in
combined operations as a whole amounted to 1.15%, with extended operations — 0.6%.
The greatest decrease in the frequency of deaths was observed when performing
combined operations — from 1.7% in the first period of work to 0.8% —in the third (p <0.05).
The main cause of death during surgery was massive bleeding,
11 of 14 patients became the direct cause of death (78.6%). 5 of them
bleeding occurred when the main branches and the pulmonary artery were damaged,
4 — aorta and in 2 patients — of the right atrium, when a tumor grows into it
pulmonary veins. Two patients died on the operating table with progressive phenomena
increasing heart weakness. Deterioration of the condition, heart disorders
activities, and then asystole occurred after ligation of root vessels
lung with increasing hypertension in the pulmonary circulation.
The cause of death on the operating table of one patient was a significant
narrowing of the common pulmonary artery involved in the blastomatous process,
when performing left-sided combined pneumonectomy.
All patients who died during the operation of the tumor process
was characterized by the presence of massive lymphogenous metastasis with a lesion
mediastinal lymph nodes, and half of them have simultaneous germination
tumors and its metastases in several extrapulmonary anatomical structures. how
It turned out at autopsy, 2 patients already had distant hematogenous
metastases not diagnosed during the preoperative examination and during
operations.

In the postoperative period, 233 of 1706 patients died.
operation, which amounted to 13.7%, while in the first period postoperative mortality
was equal to 21.2,%, in II -15.5%, in III -6.1%. Postoperative mortality in
patients undergoing advanced combined resection of the lungs by periods
clinic work decreased and amounted to 40%, 25.5%, 7.2%, and advanced resection
respectively, 12%, 9.9% and 5.3%.

Death of patients after surgeryand advancing in connection with razvitiemposleoperatsionnyh complications. In the first period of work from 526 patients who underwent surgery, various complications of the postoperative period were observed in 220 (41.8%), in the second period of work from 521 in 163 (31.3%), in the third period of work from 659 u161 (24.4 %). From the number of patients with a complicated course after the operation, 112 people died in the first period, which amounted to 50.9%, in the second period —81 patients, which amounted to 49.6% and in the third period —40, which accounted for 24.8%. Thus, the general reduction in postoperative mortality occurred mainly due to more effective therapy aimed at preventing the development of postoperative complications and only in the period of work also due to more successful treatment of their complications. Frequency of development of various postoperative complications observed in the I, II and III periods of the clinic after extended and expanded combined resections of the lung, is shown in Table 25. As can be seen from the data presented in the table, a decrease in the overall incidence of Leo-operative complications in the II and especially III periods of the clinic’s work were mainly related to a decrease in the incidence of cardiovascular inhalation insufficiency after operations. Significant changes also occurred in the structure and frequency of postoperative lethality after extended (table 26) and extended combined resections of the lungs (table 27). Still, as one of the main causes of death for patients in the postoperative period, cardio-pulmonary insufficiency remains. However, the frequency of occurrence of this severe complication, which was the cause of death of patients, has substantially decreased. But the frequency of the development of severe postoperative pneumonia, leading to death, was most significantly reduced, and in structure-related operative mortality in the second period of work, it moved from the second place to the third, giving way to a pulmonary embolism. In the III period of work, pulmonary embolism in the structure of postoperative lethality came in first place. This fact, from our point of view, there is a logical explanation. After analyzing the average life expectancy of patients who died in the postoperative period, we were convinced that it increased significantly. So, if in the first period of work it was equal to –3.1 ± 0.8 days, then in the second period –12.3 ± 2.5 days , and in the third —14.3 ± 1.8, that is, if in the first period of work the patients died mostly in the early postoperative period, then in the second, and especially in the third —in the late periods after surgery. Undoubtedly, the improvement of the anesthetic management of postoperative intensive care, the improvement of surgical techniques have dramatically reduced mortality in the early postoperative period due to more effective prevention and treatment of cardiopulmonary insufficiency, postoperative pneumonia. A low incidence of thromboembolic complications in the first period of work is apparently associated with a short lifespan, when the operated patient died earlier from other causes than from thromboembolism. The high incidence of thromboembolic complications may be due to prolongation of life after the operation in the most severe patients with complicated postoperative period . Changes in the plasma and cellular links of hemostasis, which were observed in them, undoubtedly play a large role in pathogenesis of these complications. Therefore, we consider the further study of the hemoaggregation properties of blood as a promising line of research that can provide real opportunities for the prevention and treatment of thromboembolic complications. Considering their frequency and place in structure-operative complications, this is one of the most promising opportunities for further reduction of postoperative mortality. The frequency of bronchopleural and septic complications as a cause of lethal outcomes, although decreasing, its share in the structure of lethal outcomes tends to increase. Apparently, this was due to a decrease in the overall postoperative mortality rate and an increase in the life expectancy of the patients who died, that is, in the first period, patients in some cases did not survive the development of this complication. Thus, there was a significant decrease in the postoperative lethality rates mainly due to improved therapeutic measures aimed for the prevention and treatment of cardiovascular and respiratory failure, postoperative pneumonia. A significant increase continued The number of deaths from cardiopulmonary insufficiency and postoperative pneumonia, the incidence of severe thromboembolic complications has increased, while the incidence of fatal outcomes from cardiopulmonary insufficiency and postoperative pneumonia has increased significantly. It should be noted that extended combined resections are the most traumatic. performed for lung cancer. They are more likely than other operations soprovozhdayutsyarazvitiem severe complicationsth and lead to death. Improving the organization and maintenance of the system of therapeutic measures taken by the patient both during and after surgical interventions can significantly improve the immediate results of advanced combined resection of the lung and expand the indications for their implementation.