[Intraoperative and early surgical complications after VATS lobectomy]. / Intraoperatsionnye i rannie khirurgicheskie oslozhneniya pri torakoskopicheskikh lobektomiyakh.

OBJECTIVE: To improve the results of thoracoscopic anatomic lung resections (lobectomy) via reducing the incidence of intraoperative and early surgical complications. MATERIAL AND METHODS: The study enrolled 479 patients who underwent thoracoscopic lobectomy. We determined the main criteria of complications: injury of vascular structures with severe bleeding, damage of the bronchi and adjacent organs. RESULTS: Potentially life-threatening conditions requiring additional surgical manipulations (bleeding in 35 patients, bronchial trauma in 3 patients) were diagnosed in 7.9% (38/479) of cases. Vascular injury with severe bleeding occurred in 7.3% of patients (n=35). Three patients had bronchial trauma (7.9%). We stopped bleeding without thoracotomy in 48.5% (17/35) of patients. In 51.5% (18/35) of cases, emergency thoracotomy was performed. CONCLUSION: The problem of safety is still urgent despite widespread thoracoscopy in lung resections. Knowledge of the factors contributing to complications and working out appropriate algorithm of actions are of great importance.

[Surgical treatment of lung cancer in patients over 75 years old]. / Khirurgicheskoe lechenie raka legkogo u bol'nykh starshe 75 let.

OBJECTIVE: To analyze surgical treatment of lung cancer in patients over 75 years old. MATERIAL AND METHODS: The study enrolled 73 patients. Lobectomy was performed in 50 (68.5%) patients, segmentectomy - 14 (19.2%), pneumonectomy - 4 (5.5%), bilobectomy - 3 (4.1%), wedge resection - 2 (2.7%) patients. The most common clinical scenario was lobectomy for lung adenocarcinoma stage I. Metastases in lymph nodes were noted in 32.9% of cases. Among 9 patients with pN2 (12.9%), lesion of mediastinal lymph nodes was preoperatively diagnosed in 4 (44%) cases. Mean tumor size was 3 (1-14) cm. RESULTS: Overall morbidity was 16.4%, mortality 5.5%. Multivariate analysis revealed the most significant risk factors such as stage IIIb (OR 9.3, 95% CI 1.365-63.816, p=0.023), pN1 (OR 3.889, 95% CI 1.008-14.999, p=0.049), pN2 (OR 5.300, 95% CI 1.170-23.999, p=0.030), central cancer (OR 7.572, 95% CI 1.742-32.884, p=0.007). CONCLUSION: Surgical treatment of lung cancer patients over 75 years old may be completed safely and effectively in careful preoperative selection of patients. The most important risk factors of postoperative complications are cancer stage IIIb stage, lymph node lesion and central cancer.

[Diagnostic clinical algorithm for mediastinal tumors]. / Klinicheskii algoritm diagnostikii i lecheniya opukholei sredosteniya.

OBJECTIVE: To optimize therapeutic and tactical algorithm in patients with mediastinal tumors. MATERIAL AND METHODS: The study included 300 patients with mediastinal tumors examined and treated in the Thoracic Surgery Department of the Hertzen Moscow Cancer Research Center between 2008 and 2019. Patients were stratified into 2 groups. The diagnostic group consisted of 160 patients including 80 ones after 89 ultrasound-assisted transthoracic biopsies and 80 patients after open biopsy through parasternal mediastinotomy. The treatment group consisted of 140 patients who underwent 145 resections of mediastinal tumors. We analyzed the results of diagnosis and treatment in both groups, mistakes, risk factors of non-informative biopsies and complicated course of the postoperative period. Subsequently, a clinical algorithm was developed. Its effectiveness in 50 patients was compared with 90 patients who constituted the historical control group. RESULTS: The final histological diagnosis after transthoracic ultrasound-assisted biopsy of the mediastinum was established in 71 out of 89 cases (80%). Informative value of ultrasound-assisted biopsy for thymic tumors was 100%, for metastatic mediastinal lesions - 92%. Repeated ultrasound-assisted biopsies were performed in 7 (9%) patients that made it possible to establish the final diagnosis in 5 (71%) cases. In the parasternal mediastinotomy group, the final correct histological diagnosis was made in 79 out of 80 (99%) patients. Analyzing thoracoscopic approach and traditional sternotomy or thoracotomy, we found surgery time decrease from 187 (150-215) to 140 (122-165) min (p<0.01), blood loss from 300 (200-350) to 50 (35-150) ml (p<0.01), postoperative hospital-day from 12 (9-14.5) to 7 (6-8) days (p<0.01). Mean dimension of tumor was 5 (4-6) cm in the thoracoscopy group and 7.5 (6-10) cm in the open surgery group (p<0.01). Postoperative complications occurred in 19 (13%) patients, mortality rate was 2.8%. Multivariate analysis revealed superior vena cava syndrome (OR=5.1, 95% CI=1.246-21.343; p=0.024) and invasion of the right pleural cavity (OR 4.2, 95% CI 1.12-7.69; p=0.006) as the most significant predictors of postoperative complications. The proposed algorithms made it possible to reduce the incidence of non-informative biopsy from 12% to 0% (p<0.05), misdiagnosis from 9% to 1% (p<0.05), exploratory surgeries from 23% to 0% (p<0.05). CONCLUSION: The developed algorithm is valuable to avoid the errors and improve the results of diagnosis and treatment of patients with mediastinal tumors.

[Hemangioendothelioma of the right innominate vein]. / Gemangioendotelioma pravoi plechegolovnoi veny.

The authors report a rare case of hemangioendothelioma of the right innominate vein complicated by superior vena cava syndrome. Considering development of enlarged venous collaterals, we performed circular resection of superior vena cava together with the right and left innominate veins without replacement. There were no postoperative complications. The use of vascular prosthesis in patients with long-standing superior vena cava compression and enlarged collaterals is associated with high risk of thrombosis and subsequent pulmonary embolism. Safe circular resection of superior vena cava without replacement is possible after intraoperative test clamping.

[Rethymectomy in patients with myasthenia gravis and recurrent thymoma]. / Retimektomiya u bol'nykh miasteniei i retsidivom opukholi vilochkovoi zhelezy.

OBJECTIVE: To analyze efficacy and safety of rethymectomy in patients with pathology of thymus. MATERIAL AND METHODS: Nine patients (2 males and 7 females) underwent rethymectomy in the thoracic surgery department of the Hertzen Research Institute of Oncology for the period from March 2009 to December 2019. Initial thymectomy for myasthenia gravis was performed in 6 patients, for thymoma without myasthenia - in 3 patients. Age of patients varied from 27 to 75 years (median 42.8 years). Myasthenia manifested at the age of 25-61 years (median 29.2 years). Period between manifestation and thymectomy varied from 6 to 24 months (median 12.6 months). MGFA grade IIIa was in 1 patient, grade IIIb - in 1, grade IVa - in 1, grade IVb - in 2, grade V - in 1 patient. Rethymectomy was performed via sternotomy in 4 cases, through thoracoscopy - in 5 patients. RESULTS: Postoperative complications occurred in 2 (22.2%) patients. Biopsy revealed residual thymic tissue in all patients. Median follow-up after rethymectomy was 30.2 months (range 12-132 months). Complete stable remission was achieved in 3 (50.0%) patients, remission - in 2 cases, partial remission - in 1 patient. Median dose of steroids before rethymectomy was 40 mg (range 16-96 mg), median dose after rethymectomy - 8 mg (range 0-24 mg). Differences were significant (p=0.04). All patients operated on for thymoma or recurrence are alive within 12-124 months after rethymectomy. CONCLUSION: Rethymectomy is a safe and effective treatment option for patients with refractory myasthenia gravis (especially in case of detected residual thymic tissue) or recurrent thymoma. Radical surgery for recurrent thymoma ensures favorable survival.

[Lymphatic malformation of cervical-supraclavicular area with large mediastinal component]. / Limfaticheskaia mal'formatsiia sheino-nadkliuchichnoi oblasti s mediastinal'nym komponentom bol'shikh razmerov.

Lymphatic malformation (LM) is a benign neoplasm that consists of abnormally formed lymphatic vessels and cavities. The incidence of LM is 6% among all benign tumors. Mediastinal localization is extremely rare, only case reports in adults are described. Clinical observation of 42-year-old patient with LM of cervical-supraclavicular area and large mediastinal component communicating with thoracic lymphatic duct is presented. The first stage was thoracoscopic clipping of thoracic lymphatic duct, the second one - radical surgery through combined cervico-sterno-thoracotomy.

[The theoretical and organizational basis for the Comprehensive Program for Disease Prevention and Health Improvement of the Population]. / Teoretické a organizacní základy "Komplexního programu opatrení k posílení prevence nemocí a k upevnování zdraví obyvatelstva"

The authors present a general characterization of a complex programme of disease prevention developed by the Ministry of health care, Academy of medical science and by other authorities of the USSR. At first, there is an outline of demographic and health state indicators of soviet population and of factors leading to morbidity increase. The major part of the paper deals with an analysis of the aims of this programme, i.e. air pollution control, improvement of social and medical care of working and child-bearing women, education of young people to a healthy life-style, health care of children and adolescents, reinforcement of health of young families, expanding and improvement of the recreation, sporting and cure facilities, propagation of mass-physical training, rationalization of nutrition, intensification of health education of citizens, dispensary care of population, and medical personnel education in the field of preventive medicine.