PREOPERATIVE SURVEY OF PATIENTS AND DETERMINATION OF FUNCTIONAL OPERABILITY.

The success of the surgical treatment of lung cancer patients in advanced stages of the disease largely depends on the accuracy of the preoperative diagnosis of the prevalence of the tumor process, its complications, the nature and characteristics of the existing functional disorders of the main life support systems of the body and associated diseases. Only on the basis of a reliable and complete idea of ​​the nature of the main pathological changes in the patient’s body, it is possible to determine indications for surgical treatment, to plan the most rational in direction, content and volume of preoperative preparation.

The clinical picture of lung cancer in the advanced stages of the disease is extremely diverse. It depends on the location and size of the tumor, its clinical anatomical shape, histological structure, the nature and prevalence of metastasis, the presence and characteristics of extrapulmonary spread, the nature of complications. However, the diagnosis of the underlying disease in patients with advanced stages of lung cancer, as a rule, does not present great difficulties and is often carried out already at the stage of an outpatient examination.

The most difficult problems that have to be solved during the preoperative examination are morphological verification and diagnosis of the prevalence of the tumor process, diagnosis of the nature and severity of pathological disorders of the functional status of patients. Speaking about the advanced stages of lung cancer, they come down to establishing contraindications for surgery, which make surgical intervention technically impossible or oncologically impractical, or, taking into account the general condition of the patient, intolerable to this patient.

The main tasks of preoperative diagnosis can be reduced to the following:

1. The diagnosis of the underlying disease (lung cancer) with morphological verification of the tumor process;

2. Diagnosis of the local spread of the tumor, both intrapulmonary and extrapulmonary, with the specification of the nature and extent of the lesion of various extrapulmonary anatomical formations and organs of the chest cavity, lymphatic apparatus;

3. Diagnosis of complications of lung cancer, which is mainly associated with the establishment of the nature and severity of paracancrotic inflammatory changes;

4. Diagnosis of the presence of generalization of lung cancer with a refinement of the localization and extent of the lesion by distant hematogenous and lymphogenous metastases;

5. Diagnosis of concomitant and competing diseases;

6. Establishment of the nature, severity and characteristics of existing functional disorders of the basic life support systems of the body.

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