The experience of surgical treatment of patients with lung cancer in the clinic for the period 1960— inclusive was studied. The analysis of clinical observations is divided into 3 stages: from 1960 to 1975, from 1976 to 1986 and from 1987 to 1995. Such a division makes it possible to more objectively evaluate the fundamental approaches and attitude to performing extended and expanded combined resections over the course of 35 years of the clinic’s work. In the further presentation, these stages will be referred to as I, II and III periods of work.
For many decades, the clinic has been one of the largest specialized medical diagnostic and advisory centers in the city. Over the period 1960s, about 19,500 inpatients and outpatients were sent to the clinic for consultative admission, in which clinical signs of the disease and radiological changes suggested the development of lung cancer.
As a result of an outpatient examination, which included a complex of X-ray, endoscopic and functional research methods, 4920 patients were diagnosed with lung cancer, which accounted for 25.2% of all examined. The examination was extended to all patients diagnosed with lung cancer: the prevalence of blastomatous changes, the state of the functional and reserve capabilities of breathing, and the cardiovascular system were assessed. The absence of signs of hematogenous dissemination of the tumor, other evidence of inoperability, allowed hospitalizing 3505 patients with lung cancer in the clinic to resolve the issue of surgical treatment, which accounted for 71.2% of all patients with an established diagnosis of the disease. Moreover, in the first period of the clinic’s work, 1239 out of 1770 (70%) were hospitalized, in II –1054 out of 1450 (72.7%) and in the III period –1212 out of 1700 patients (71.3%).
The clinic conducted an in-depth targeted examination of each patient, and often functional operability was re-evaluated after a course of treatment aimed at stabilizing and improving the activity of the cardiovascular system and respiratory organs, and increasing the body’s defenses. This made it possible to most fully identify the reserve capabilities of the main vital systems and organs of patients to clarify indications for their surgical treatment. Surgical interventions were performed in 2524 lung cancer patients (72%), moreover, 958 of 1239 hospitalized lung cancer patients (77.3%) were operated on in the I period, 726 out of 1054 (68.9%) in the II period, and in the III period 840 out of 1212 (69.3%). Data characterizing the surgical work of the clinic for the treatment of patients with lung cancer for the period 196 0— years are presented .
As can be seen from the data presented, the main type of surgical interventions performed in the clinic for lung cancer are extended and expanded combined resections. In the structure of surgical interventions, they account for a total of 68.2%. Moreover, there is a tendency towards their increase (p <0.001). So, while in the first period of the clinic’s operation, extended and expanded combined resections amounted to 55.6% of the total number of surgical interventions for lung cancer, in the second period of work their share increased to 72.3%, and in the third period to 78.9% . With a relatively constant number of test thoracotomies (p> 0.05), which constitute a total of about 11%, an increase in the number of extended and expanded combined resections was accompanied by a sharp, decrease (p <0.001) in the number of simple resections in
structure of surgical interventions, from 32.6% in the first period of work to 10.2% in III. This trend in the surgical work of the clinic is due to at least two circumstances. Firstly, the contingent of patients with lung cancer entering the clinic, most of which had advanced stages of the disease. So, among those hospitalized in the clinic, stage III lung cancer was assumed in 65%. In-depth preoperative examination and, especially, intraoperative diagnosis required a review of the stage of tumor development in the direction of its increase in another 10% of patients. Secondly, by expanding the indications for surgical interventions in patients with lung cancer in the advanced stages of the disease, both by narrowing the contraindications for surgery due to the prevalence of the tumor process and the functional inoperability of patients. Among patients with lung cancer with advanced stages of the disease, the most difficult category were patients in whom the tumor spread to extrapulmonary formations and organs of the chest cavity. His radical surgical intervention included, along with the resection of the lung or its part, the obligatory resection of the affected anatomical structures and organs of the chest cavity, that is, the performance of combined resections. Of the 2524 lung cancer surgeries performed at the clinic in the 1960s, 605 were extended combined lung resections, which accounted for 24%, and among extended resections, 35.2%.