The frequency of histological types of lung cancer among all operated patients, as well as in various groups depending on gender, age, and the clinical and anatomical form of the tumor, is shown in the figures.
The size of the tumor in the lung is recognized as an important criterion for assessing the prevalence of the blastomatous process, and, consequently, for resolving issues of therapeutic tactics. Most modern classifications of malignant tumors take it into account as an integral element of the general characteristics of the blastomatous process. Only in 30 patients the tumor size did not exceed 2 cm across. In 121 patients, they ranged from 2.1 cm to 3.0 cm, in 152 from 3.1 cm to 4.0 cm, in 492 from 4.1 cm to 5.0 cm. In 479 cases, the diameter of the tumor was from 5.1 cm to 6.0 cm, and in 446 patients exceeded these sizes. Thus, extended and expanded combined lung resections were performed, as a rule, in patients with a large size of the primary cancerous tumor. In 53.8% of all cases, the size of the tumor at the time of surgery was more than 5 cm in diameter. This largely determined the significant volume of the operation and the technical features of its implementation.
An important feature of the blastomatous process in advanced stages of lung cancer is extensive lymphogenous metastasis. So, from 1720 operated patients, lymphogenous metastases were detected in 1471 (85.5%). At the same time, only 359 patients (20.9%) had interlobar lymph nodes and lymph nodes of the root of the lung. In the vast majority of cases, 1112 patients (64.6%) had a more extensive and extended lesion – mediastinal lymphatic collectors. Metastasis to the lymph nodes of the mediastinum, as a rule, was widespread in nature with the simultaneous defeat of several groups of lymphatic collectors. Moreover, in 357 patients (20.8%), the fusion of several groups of metastatically changed mediastinal lymph nodes into a massive tumor conglomerate, widely covering extrapulmonary formations and organs of the chest cavity, was observed. Single metastases to the lymph nodes of the mediastinum were rare and were noted in only 194 patients, which amounted to 11.3% of the total number of patients operated.
Tumor metastases in the mediastinal lymphatic collectors are a common cause of blastomatous lesions of extrapulmonary formations and organs of the chest cavity. With advanced stages of lung cancer, it can be difficult to establish the true nature of such lesions. However, a thorough macro- and microscopic study of operating drugs made it possible to answer this question and establish that in 268 out of 605 patients who underwent extended combined resections (44.3%), damage to extrapulmonary formations and organs of the chest cavity was due to germination in them primary tumor node, in 204 patients (33.7%) metastases to the lymph nodes of the root of the lung and mediastinum, and in 133 patients (22%), both of these tumor elements.
The frequency of tumor lesions of various extrapulmonary formations and organs of the chest cavity of 605 operated patients is shown in Figure 15. Most often, in 60.1% of all cases, pericardial damage was observed, requiring the resection of the pericardium. The involvement of the mediastinal pleura in the tumor process was noted in all lesions of the formations and organs of the mediastinum. However, only in a third of patients (31.5%) it was widespread, requiring extensive removal of the mediastinal pleura with resection of the vagus and phrenic nerves.