[The criteria for choosing the extent of the resection of neighboring organs (structures) in lung cancer patients]. / Kriterii vybora ob''ema rezektsii sosednikh organov (struktur) u bol'nykh rakom legkogo.

Clinical and morphological criteria for the extent of resection of the adjacent organs (structures) involved in the metastatic process were defined by analyzing 598 extensive, combined, and extensive-combined operations for giant-cell carcinoma of the lung. Morphological studies of the serial sections of resected intrathoracic structures showed that the true margins of the process extent do not always correspond to those determined on revision or palpation. It was indicated that for radical intervention, the pericardium should be resected at least at 2 cm from the visible invasion edges when a tumor is extended into it. When the process is extended into the diaphragm and chest, resection should be made at least at 2 cm of the tumor edges. In endobronchial carcinoma, the bronchus should be dissected at a distance of at least 1 cm from the tumor edges, but in peribronchial and mixed forms, it should be done at least at 2 cm. Intraoperative morphological studies are demonstrated to be of high diagnostic value in identifying the local and regional extent of lung cancer.

[Effects of surgical complications on trace element metabolism in patients with cardio-esophageal and esophageal cancer]. / Vliianie khirurgicheskikh ozlozhnenii na obmen mikroélementov u bol'nykh kardioézofageal'nym rakom i rakom pishchevoda.

The homeostatic features of trace elements were studied in 48 patients with cardio-esophageal and esophageal carcinoma in development of incompetence of the anastomosis sutures (17), peritonitis (19), and intestinal fistulas (12). The level of the trace elements was determined in the red cells, blood plasma, and urine by emission plasma spectrometry. With the development of surgical complications after operation on the stomach and esophagus, the metabolism of trace elements was sharply disturbed, catabolic processes prevailed and were manifested by the escape of essential trace elements from the cells and their excretion in the urine. The changes of trace elements metabolism were more profound in peritonitis and intestinal fistulas. Complex intensive therapy including artificial feeding corrected partly the metabolic disorders.

Successive radiation and surgical treatment of esophageal cancer.

On the basis of our extensive experience with radiation therapy, surgery, and combined therapy in the treatment of esophageal cancer, we substantiate a basis for giving irradiation followed by surgery. With the high efficacy of radiotherapy (RT), achieving tumor regression of more than 75% with a dose 40-50 Gy, it is expedient to continue RT using a radical programme. This may lead to full recovery without any surgical intervention. However, these patients must be followed-up. If tumor growth continues or if there appears a recurrence of tumor later, a radical operation must be performed (56 clinical cases). During the operation, extirpation of the esophagus with esophagoplasty, or its resection with a one-staged reconstruction with the gastrointestinal tract, is possible. The latter is preferred, as it not only increases the patients' life-span with comparatively low operative mortality, but results in full recovery of some patients.

[Disorders of trace element metabolism and their correction using artificial nutrition in patients with cancer of the esophagus in the preoperative period]. / Narusheniia obmena mikroélementov i ikh korrektsiia s pomoshch'iu iskusstvennogo pitaniia u bol'nykh rakom pishchevoda v predoperatsionnom periode.

Findings of research into disorders of the micronutrient exchange in esophageal carcinoma patients are overviewed. The micronutrient level in the plasma, erythrocytes, and urea was estimated by means of emission plasma spectroscopy. Patients with esophageal carcinoma were found to have pronounced changes in the micronutrient exchange on their admission into the clinic. These changes were corrected by means of artificial nutrition, which included preparations with directed action and micronutrients. After the course of therapy a tendency towards normalization of the micronutrient exchange was observed.

[Disorders in the sequence of regional metastasis and long-term results of the surgical treatment of complicated lung cancer]. / Narushenie posledovatel'nosti regionarnogo metastazirovaniia i otdalennye rezul'taty khirurgicheskogo lecheniia oslozhennogo raka legkogo.

To ascertain the frequency of disturbance of the stage character of regional metastasis in lung carcinoma complicated by disintegration or obstructive pneumonitis, and its influence on certain results of surgical treatment, the authors analysed the data on 175 patients who underwent lung resection. The stage character of regional lymphogenous metastasis was found to be disturbed in 61 (34.8%) patients, in 52 (85.2%) of them the main disease was complicated by obstructive pneumonitis. Five-year survival in the group of patients without disturbance of the stage character of metastasis was 28 +/- 4.8%, which was significantly greater than that in the group of patients with a disturbed stage character (15.5 +/- 5.2%).

[Preoperative diagnosis of residual tumor in esophageal cancer following radiation therapy]. / Predoperatsionnaia diagnostika ostatochnoi opukholi pri rake pishchevoda posle luchevoi terapii.

The authors analyse 100 operations for resection of the esophagus after radiotherapy. Morphological examination before irradiation showed squamous cell carcinoma in all patients. Difficulties arise in the diagnosis of a residual esophageal tumor after radiotherapy, as a result of which 11 (14.5%) of 76 patients irradiated with a dose of 30-40 GY and 1 (4.2%) of 24 patients who received a dose of 50-70 Gy were exposed to the risk of a surgical intervention in the absence of morphological signs of a tumor in the removed esophagus. The difficulties of the diagnosis are due to resorption of the tumor under the effect of radiotherapy, its exophytic component in particular, the frequent submucosal position of the tumor, signs of therapeutic pathomorphosis of the tumor, and fibrosis of the esophageal wall.

[The highest permissible levels of resection of the esophagus in cancer during surgery with intrathoracic or cervical esophagogastric anastomoses]. / Predel'no vysokie urovni rezektsii pishchevoda po povodu raka pri operatsiiakh s vnutrigrudnym ili sheinym pishchevodno-zheludochnym anastomozom.

The levels of esophageal resection for squamous carcinoma were determined in 84 patients by measuring the distance from the incisors to the ring of the esophagogastric anastomosis during esophagoscopy. The radicalism of the operations was evaluated from the difference in the distance between the incisors and the upper border of the tumor and the distance between the incisors and the anastomosis. The mean levels of the highest possible resections of the esophagus were at a distance of 33.5 +/- 2.8, 23.6 +/- 2.0, and 20.4 +/- 2.0 cm from the incisors, respectively, in Garlock's operation, Lewis' operation, and Dobromyslov-Torek's operation with esophagoplasty using an antiperistaltic gastric pedicle. It is suggested that the choice of the method of surgical treatment should be based on comparison of the determined levels of the highest possible resection of the esophagus with the endoscopic assessment of the level of the upper border of the tumor in the esophagus.

[Clinical evaluation of the small-cell and poorly differentiated forms of squamous-cell and glandular lung cancers]. / Klinicheskaia otsenka melkokletochnogo i malodifferentsirovannykh form ploskokletochnogo i zhelezistogo raka legkogo.

The paper deals with the results of analysis of the data on 263 cases of lung cancer (small-cell--145, poorly differentiated--63 and glandular--55). Clinical manifestations and treatment procedures are discussed. The advantages offered by radical surgery used as a component of combined treatment for small-cell cancer are presented. No gain in survival was obtained by application of extended or combined surgery as compared with conservative treatment. In poorly differentiated carcinoma, radical surgery was shown to improve the end results in cases of limited expansion of tumor without involvement of the lung root or mediastinal lymph nodes.

[Healing of esophagogastric anastomosis performed with the use of compression suturing equipment]. / Zazhivlenie pishchevodno-zheludochnogo anastomoza, nalozhennogo s pomo'shchiu kompressionnykh sshivaiushchikh apparatov.

The authors' findings permit a conclusion that a compression formation of an esophagogastroanastomosis is a simpler and more reliable method than other techniques used in cases of proximal resection of the stomach. The anastomosis sutures have failed in only one of the 44 surgeries. The surgical procedure is the same as that used when the routine IIKC or CIITY equipment is employed. Unlike the anastomoses formed manually, compression anastomoses rule out one of the major drawbacks of a suture made by hand, i.e. bacterial contamination of the anastomosis area. Clamps and needles of the compression rings in anastomoses formed by means of compression apparatus AKA-2 and modified CIITY apparatus with silicone gaskets are free of the wick characteristics typical of the common suturing material, when the bacterial flora is transported into the deep-lying layers of the anastomosed organs along the thread fibers from the side of the mucosa. Resection of the proximal portion of the stomach and the lower thoracic portion of the esophagus has been carried out in 2 patients, making use of a compression anastomosis. The course of the postoperative period has been normal.

[Prognosis of survival time in year prior to the start of radiotherapy of epidermoid carcinoma]. / Prognozirovanie godovoi prodolzhitel'nosti zhizni do nachala luchevoi terapii épidermoidnogo raka.

The results of radiation therapy of 117 patients with squamous cell lung carcinoma taking into account yearly survival were analyzed. Clinico-laboratory and roentgenological factors of prognosis were identified. The use of methods of mathematical statistics and a method of structural risk minimization made it possible to work out a decision rule permitting prognosis of yearly outcome of disease with the minimal probability of 72% even before the start of radiation therapy.