The spread of tumor cells along the wall of the bronchus occurs predominantly in the submucosal layer and adventitious membrane. Thus, out of 29 patients who had tumor invasion, 13 (44.8%) patients, the spread of tumor cells was noted in the submucosa, in 7 (24.1%) in the adventitious membrane and in 8 (27.6% ) —In both sheaths of the bronchus simultaneously. Only one patient (3.5%) observed the spread of tumor cells through the mucous membrane. However, in all patients, regardless of the presence of tumor invasion, a significant change in the mucous membrane was noted — 3 and more cm, which was characterized by hyperplasia of the goblet cells, squamous metaplasia, and at a distance of 5 mm to the tumor and dysplasia of the mucosa. In the mucosa on the same length was observed cellular infiltration,more often represented by histiocytes, less often by lymphocytes and leukocytes.

It should be noted that the most stable element of the bronchus to germination was cartilage by tumor tissue. The spread of tumor cells in the cartilage was not detected in any case. Moreover, even for several mm deep into the tumor, only the perchondrium was affected, and in the cartilage itself only dystrophic changes were observed .

Tumor cells in the wall of the bronchus grew into layers up to 6 mm from the visible macroscopic border of the tumor, and over 6 mm stretched mainly along the blood and lymphatic vessels. However, in 2 cases, tumor invasion could be considered only from the standpoint of the “tumor field” theory of RAWillis (1953), according to which the formation of a tumor proceeds at different points with their further merging into one node. In this case, neoplastic transformation occurs in stages, non-simultaneously: a mosaic pattern occurs — zones of normal tissues, proliferating, malignant. The same picture was also observed when, at a considerable distance from the tumor, more than 10 mm, we found the presence of tumor cells in the submucosal layer not connected with the main tumor node. In the literature there are data on the size of the “tumor field” in various organs,but information about him in lung cancer we have not met. Considering the presence of significant changes in the mucous membrane, regarded as precancerous, it can be assumed that the size of the “tumor field” according to the bronchus for lung cancer may exceed 30 mm.

Thus, there is reason to believe that the spread of tumor cells along the wall of the bronchus or trachea proximal to the visible border of tumor growth can reach a considerable extent, up to 30 mm or more. The probability of detecting tumor cells depends on the magnitude of the distance from the tumor growth border and follows the exponential distribution law. According to the data obtained, with the cut-off of the bronchus or trachea at a distance of 15 mm from the visible edge of the tumor, in 95% of all cases, a guarantee is achieved against leaving tumor cells. However, in each case it is advisable to conduct an urgent histological examination of a section of the bronchus of the removed drug.

Tumor invasion is also observed in other extrapulmonary organs and tissues affected by the blastomatous process. So, yes nnym , pericardial tumor cells were determined at 1.5 cm from the visible boundaries of tumor ingrowth into 2.5 ± 1.8%, in the chest wall at a distance of 2 cm – 7.4 ± 5.0%, in the diaphragm at a distance of 1.5 cm in one of six operated patients. The dependence of the extent of tumor invasion of various anatomical structures on the degree of cell differentiation of the tumor, the nature of its growth, the presence of metastatic damage to the regional lymph nodes of the lung was noted (ShnitkoS.N., 1993). Therefore, when determining the amount of resection of extrapulmonary anatomical structures and organs of the thoracic cavity, it is necessary to take into account the patterns and characteristics of the local spread of lung cancer, resorting in all doubtful cases to an urgent morphological study of the edge of the resected tissue.

An important technique that provides ablastic surgery is the need for careful handling of the affected tissues, especially when the lung is released from adhesions, as rough manipulations that cause trauma to the tumor contribute to the dissemination of the pleural cavity with cancer cells and their spread through the blood vessels . Back in 1967, A.S. Barchuk showed that tumor cells in the washings from the pleural cavity were found after resection of the lung for cancer 2 times more often than before surgery. Some surgeons recommend starting pneumonectomy or lobectomy with ligation of the pulmonary veins in order to prevent the spread of cancer cells krovenocnomu Russian lu .

Antiblastika provides application during surgery for lung cancer events, preventing the dissipation and abandonment in the pleural cavity of viable tumor email ementov . This includes the use of wound irrigation with alcohol or other means during the surgical intervention that can have a detrimental effect on tumor cells, washing the pleural cavity after the main stage of the operation has been completed for their mechanical removal, repeated washing of hands and tools during the operation, changing of the operating linen, using diathermic currents (electrosurgery) for tissue dissection and hemostasis.