[Intraoperative radiation therapy: its technological support, potentials and prospects]. / Intraoperatsionnaia luchevaia terapiia: tekhnologicheskoe obespechenie, vozmozhnosti, perspektivy.

The authors' experience with intraoperative radiotherapy (IORT) in 129 patients with a tumorous process at various sites has demonstrated that in most clinical events, single radiation doses of 10-20 Gy is insufficient to have a persistent local effect and requires additional pre- or postoperative remote irradiation. The use of IORT as a single component of radiation exposure does not lead to significant radiation damages to normal tissues. When IORT is combined with remote irradiation (the latter using doses of 30-60 Gy), 30% of patients develop radiation-induced normal tissue lesions. In the context of enhancing the local effect and, if possible, decreasing the dose of remote irradiation, it is expedient to increase IORT doses, which is in turn fraught with higher incidence and severity of radiation lesions. In this connection, it seems urgent to have a look for the potentialities to expand the radiotherapeutical range. This follows several directions.

[Potentialities of CT with densitometry in the assessment of local diffusion of esophageal cancer]. / Vozmozhnosti KT s densitometriei v utochnenii mestnoi rasprostranennosti raka pishchevoda.

Computer-aided tomographic (CT) examination of 94 patients with esophageal cancer was carried out. Densitometric analysis of computer image of esophageal tumors making use of profile density histograms is presented for the first time. Objective graphic criteria for assessment of the depth of tumor invasion have been developed. CT results were correlated to intraoperative findings and data of histological examination of removed tumors. The sensitivity of the method in assessment of esophageal cancer dissemination was 97.7%, specificity 93.4%.

[Methods for increasing graft survival in esophagogastroplasty]. / Puti povysheniia zhiznesposobnosti transplantata pri ézofagogastroplastike.

From their own clinical material the authors revealed that insufficient venous outflow was the main link in the pathogenesis of impaired viability of the pedicle formed from the greater curvature in esophagoplasty. This leads to circulatory disorders in the graft: venous hypertension of up to 34.4 +/- 2.3 cm inadequate perfusion of tissue, and secondary arterial hypotension below 40 mm Hg. The authors suggested an original pathogenetically substantiated method of esophagoplasty with a pedicle from the greater curvature of the stomach. Its essence consists in the creation of an additional venous outflow from the graft into the neck veins. Operations were performed on 55 patients with the formation of 70 intravenous anastomoses. The suggested method made it possible to form a longer graft and reduce considerably the number of necrotic complications in esophagoplasty. A reliable graft of sufficient length allowed the immediate and late-term results of treatment and rehabilitation of patients with esophageal carcinoma to be improved essentially.

[Specifics of endocrine regulation of digestion in patients with esophageal neoplasms after esophagogastroplasty]. / Osobennosti éndokrinnoi reguliatsii pishchevareniia u bolnykh rakom pishchevoda posle ézofagogastroplastiki.

In 67 patients with esophageal cancer, the peculiarities of endocrine regulation of alimentation after resection and plasty of the esophagus, using an isoperistaltic gastric tube were studied. Of these patients, 15 underwent correction of the disorders revealed. Accelerated evacuation of the content from a gastric transplant is accompanied by atony of the pylorus and is due to relative incompetence of neuroendocrine elements in gastric and duodenal mucosa (presence of a small amount of EC- and P-cells). Use of pentagastrin at the early postoperative period permits to accelerate the process of formation of the compensatory-adjusting mechanisms in the system of alimentation due to increase in functional activity of EC- and I-cells.

Combined therapy of thoracic esophageal cancer.

High rates of esophageal cancer in advanced stages and poor short- and long-term results with surgical treatment have led to the use of combined treatment regimens. There is, however, no unanimity as to the most effective preoperative therapy or the most effective therapeutic tactics. In combined therapy we are in favor of strict compliance with the sequence of abdominal exploration, radiotherapy, and finally surgery. A differentiated approach according to the resectability of the lesion should be maintained. With regard to metastatic spread, nodes located in the paracardiac area and lesser omentum must be regarded as regional for the thoracic esophagus. Thirty percent of patients with metastases to these nodes survive more than 5 years after combined therapy. Based on our extensive experience in combined therapy plus an analysis of the literature we have formulated the features that will indicate palliative surgery. Differentiation between types of operations serves to determine more accurately the prognosis and the planning of further therapeutic tactics. With palliative surgery adjuvant treatment must always be given.

[Extracavitary esophageal end-to-side anastomosis in esophagoplasty with a tube formed from the greater curvature of the stomach]. / Vnepolostnoi pishchevodnyi anastomoz konets v bok pri ézofagoplastike trubkoi iz bol'shoi krivizny zheludka.

The article discusses information on experience in the formation of 367 extracavitary esophageal anastomoses in esophagoplasty with a tube formed from the greater curvature of the stomach in malignant esophageal tumors. Four main types of anastomosis were encountered: oblique--142, end to end--101, end to side--91, and atypical--33. Various complications occurred in 40.3% of patients, in end to side anastomosis in 26.3% of cases. The authors discuss in detail the operative techniques and the indications for this type of anastomosis. The authors consider it preferable to form the extracavitary esophagogastric anastomosis on the posterior wall of the transplant with a decompression stoma.

[The effect of preoperative radiation therapy on the results of the combined treatment of esophageal cancer]. / Vliianie preoperatsionnoi luchevoi terapii na rezul'taty kombinirovannogo lecheniia raka pishchevoda.

The authors resorted to multifactor comparative analysis of the results of surgical (218) and combined (413) treatment of patients with thoracic esophageal cancer to study the interrelationship of the main factors, determining a cancer stage, their prognostic value, and a degree of influence of preoperative modalities on these factors. Preoperative irradiation was shown to increase resectability of the esophagus with tumor extent over 5 cm and to improve the prognosis of disease.

[Radiodiagnosis of metastases to the upper abdominal and retroperitoneal lymph nodes]. / Metody luchevoi diagnostiki metastaticheskogo porazheniia verkhnikh abdominal'nykh i zabliushinnykh limfaticheskikh uzlov.

The examination of 170 patients with cancer of the esophagus and proximal stomach made it possible to specify x-ray, ultrasonic and CT signs of cancer metastases to the upper abdomen and retroperitoneum. A scheme of radiodiagnosis of these metastases is suggested. The diagnostic value of x-ray, echography and CT was considered in relation to various lymph nodes involvement.

[The role of computerized tomography in the diagnosis of regional metastases of cancer of the esophagus and the proximal part of the stomach]. / Rol' komp'iuternoi tomografii v diagnostike regionarnykh metastazov raka pishchevoda i priksimal'nogo otdela zheludka.

Computed tomography (CT) findings were compared with operative ones for 50 patients with esophageal and proximal gastric cancer. In diagnosis of metastases to the upper abdominal and retroperitoneal lymph nodes ST sensitivity reached 93.3%, specificity 85% and accuracy 90.3%. The best diagnostic results were obtained in detection of metastases to the nodes of the celiac trunk branch and paraaortal fat (94.2%). Lower CT resolution appeared in diagnosis of perigastric node metastatic involvement in the primary tumor location in the proximal stomach.

[Results of simultaneous resection and plastic surgery of the esophagus with extra-cavitary cervical esophagostomy in esophageal cancer in its thoracic part]. / Rezul'taty odnomomentnoi rezektsii i plastiki pishchevodas vnepolostnymanastomozom na shee pri rake grudnogo otdela pishchevoda.

The work analyses the results of one-stage resection and plastics of the esophagus with a tube formed from the greater curvature of the stomach and creation of an ++extra-cavitary anastomosis on the neck in combined and surgical treatment of carcinoma of the thoracic esophagus in 279 patients. Various complications occurred in 181 (64.8%) patients. The mortality was 19.3% (16.8% among patients who underwent radical operation and 25.6% among those treated by a palliative operation). The number of complications in the groups of surgical and combined treatment was approximately equal. The results of 5-year survival were better in the group with combined treatment. Postponed + extra-cavitary anastomosis was formed in 65.2% of cases. One-stage resection and plastics of the esophagus with ++extra-cavitary anastomosis is an adequate operation from the oncological standpoint in the treatment of carcinoma of the thoracic esophagus. Its further perfection is necessary for improvement of the immediate and late-term results of treatment.

[Endocrine function of the pancreas after radical surgery in esophageal cancer]. / Endokrinnaia funktsiia podzheludochnoi zhelezy posle radikal'nykh operatsii pri rake pishchevoda.

Postoperative levels of insulin and morphological pattern of beta-cells of islets of Langerhans were studied in 27 esophageal cancer patients following one-stage esophageal resection or repair with the gastric pedicle graft and extracavitary cervical shunt. There is a postoperative inhibition of secretory activity of the insulin pancreatic apparatus which recovered on 120 postoperative day. These shifts resulted from dystrophy of the beta-cells.

[Molecular mechanism of hemosorption]. / K voprosu o molekuliarnykh mekhanizmakh deistviia gemosorbtsii.

Several humoral and intracellular components of blood were investigated in patients with esophageal carcinoma treated with preventive hemosorption + chemotherapy, and also in patients with purulent complications after surgery before hemosorption, during hemosorption and 3 hrs, 1, 3 and 7 days after hemosorption. It was demonstrated that during hemosorption and in the first days following it no significant changes occurred either in blood count or in protein content, protein composition, levels of alpha 1-AT, IgG, IgA and IgM in blood plasma. Preventive hemosorption did not cause hypo- or dysproteinemias in these patients. Hemosorption led to normalization of certain biochemical indices of blood: increase in BAEE activity and decrease in the level of middle molecular toxins, which indicated the reduction of endotoxicosis in patients. During hemosorption there was a marked (100-200 times) increase in blood plasma of lactoferrin, which is a component of specific granules in neutrophils. It is assumed that the leading modifying mechanism of action of hemosorption is an output of physiologically active components the main of which is lactoferrin.

[X-ray diagnosis of the spread of cancer of the esophagus to the trachea and major bronchi]. / Rentgenodiagnostika rasprostraneniia raka pishchevoda na trakheiu i glavnye bronkhi.

X-ray and endoscopic investigations were compared in 80 operated on patients to estimate the role of the x-ray method for a choice of adequate therapeutic tactics for esophageal cancer patients. Operations were explorative or palliative resulting from the involvement of the tracheobronchial tree in a tumor process. The efficacy of the x-ray method in the detection of tracheal compression by an esophageal tumor is higher than that of tracheobronchoscopy which in its turn, has its advantages in the determination of tumor spreading to the left major bronchus.

[Errors in the diagnosis of malignant tumors during the prehospital stage]. / Oshibki diagnostiki zlokachestvennykh opukholei na dogospital'nom étape.

A group of experts from The P. A. Herzen Research Institute of Oncology reviewed 6000 histories of cancer. The analysis showed errors by outpatient hospital staff to account for untimely diagnosis of cancer in the majority of cases of advanced disease. A classification of medical errors was developed. Objective and subjective factors leading to errors were analysed. Review of records of diagnostic data is suggested. It is also suggested that physicians should bear responsibility for errors in oncology which have grave consequences.

[Metastasis as a prognostic factor in cancer of the thoracic segment of the esophagus]. / Metastazirovanie kak faktor prognoza pri rake grudnogo otdela pishchevoda.

Prognostic value of metastases is analyzed on the basis of the results of surgical and combined treatment of 631 cases with carcinoma of the thoracic portion of the esophagus. The metastasizing factor was found to correlate with the depth of the tumor invasion and size. The presence of metastases reduces the possibility of radical operations and lowers the index of 5-year survival.