[Possibilities of surgery optimization for esophageal carcinoma in age-related aspect].

The article presents an experience of treatment of 180 patients with esophageal carcinoma. A resection of the esophagus with the gastric graft plasty was performed using original methods in 163 patients. There were 74 patients at a mature age and 89 patients at an elderly and senile age. The method of Doppler-echocardiography was applied for the assessment of cardiovascular and respiratory systems. Results of surgery correlated with both groups. It allowed the recommendation of more wide application of surgical aids in elderly age group. Postoperative lethality consisted of 4.1% for mature patients and 10.1% for the patients at the elderly and senile age.

[Ways of indication rise for operation in elderly and senile aged patients with stomach cancer].

An article presents an analysis of treatment of 113 patients (aged from 60 to 91 years old) with stomach cancer. On this basis, an algorithm of examination of given age group was developed. Preoperative diagnostics wasn't directed only to an establishment of prevalence, a stage of main process. At the same time, it was aimed to determination and correction of accompanying somatic pathology, which required an application of multidisciplinary approach. An echocardiography was used for a functional condition assessment of cardiovascular and respiratory systems. The strategy allowed the indication rise for operation up to 96.5% in given group of patients.

[Improvement in the diagnosis, therapy, and prevention of complications in patients with rectal cancer].

The goal of this study was to assess the informative yield of modem radiology diagnostic (endorectal and intraoperative sonography, spiral computed tomography and magnetic resonance imaging) and three-dimensional modeling methods in patients with rectal cancer. The effectiveness of postoperative immune-modulating therapy (Neovir and Betaleukin) was also evaluated. The aforementioned techniques contributed to an adequate preoperative selection of surgical treatment and allowed reducing the incidence of postoperative complications.

[Computer modeling in surgical treatment of rectum cancer].

154 patients with rectal cancer were divided into the main group and the control group. All of them were investigated using endorectal and intraoperative sonography, spiral computer tomography and magnetic resonance tomography. Basing on the data of radial diagnostics pelvis model with tumour projection into rectum, bladder, ureters, prostate, uterus and vagina was recieved in all patients from the main group using Power SHAPE programm. Application of modern radial techniques and 3D modeling in diagnostics of rectal cancer contributes to adequate extent of surgical treatment adjacent with increased amount of radical operations (from 50% to 81,5%) and improvement of prognosis and survival rate in postoperative period.

[The role of tension plasty in surgical treatment of vast and gigantic postoperative ventral hernias].

An experience with treatment of 106 patients with vast and gigantic postoperative ventral hernias is summarized who were subjected to tension plasty of the abdominal wall with supraapo-neurotic fixation of a synthetic reticulate prosthesis. Monitoring of the mean calculated pressure in the pulmonary artery was made in 84 (79%) patients, in 34 (32%)--the intra-abdominal pressure. Local complications were registered in 13 (12.3%) of the operated patients, general ones--in 2 (1.9%). There were no lethal outcomes. Long-term results were studied in terms up to 9 years, no recurrent hernias were detected. A conclusion was made that the method of plasty was safe, effective and gave stable good immediate and long-term results.

[Resources of modern methods of radiodiagnostics in optimization of surgical treatment of patients with rectum cancer].

An investigation of the information value of modern radial methods of diagnostics (endorectal and intraoperative sonography, spiral computed and magnetic resonance imaging) and Power Shape program for three- dimensional modeling in 150 patients with rectum cancer has shown their significance in the assessment of prevalence of the tumor process, invasion of the tumor into the rectum wall, its spreading in the intestinal wall, involvement in the tumor process of the pararectal fat and adjacent to the rectum organs of the small pelvis, the presence of signs of metastases to the regional lymph nodes. These methods of X-ray analyses and three- dimensional computed modeling of the tumor process of the rectum facilitate preoperative decision on the adequate volume of surgery.

[Long-term outcome of surgical treatment of patients with esophageal cancer]. / Otdalennye rezul'taty khirurgicheskogo lecheniia bol'nykh rakom pishchevoda.

Under study were the results of surgical treatment of 185 patients with esophageal carcinoma. One-year survival was 75.4%, 2-year survival was 49.6%, 3-year--43.4%, and 4-year survival--33.3%. Among the patients with tumors with the invasion degree T1, T2, T3 and having no metastases to the regional lymph nodes the resection of the esophagus in combination with the extended lympho dissection resulted in 4-year survival in more than 50% of the patients operated upon. In patients with tumors T3N1, T4N1 and especially with the simultaneous involvement of several lymph collectors the 4-year survival was 21.4%. The operative intervention at this stage of the disease should be considered as a palliative means in the greater part of the patients.

[Lymph node dissection in esophageal cancer]. / Limfodissektsiia pri rake pishchevoda.

Results of surgical treatment of 70 patients with carcinoma of the thoracic part of the oesophagus were analyzed. The extended two-levels (intraabdominal and intrathoracic) lymphodissection is the necessary part of the operation. Postoperative lethality was 2.9%, one year and 2 years survival was 85.8 and 69% correspondingly. The data obtained show that it is expedient to introduce the extended two-levels lymphodissection into clinical practice.

[Operability and resectability of esophageal cancer]. / Operabel'nost' i rezektabel'nost' pri rake pishchevoda.

An experience with treatment of 193 patients with carcinoma of the thoracic part of the esophagus during the recent 7 years is generalized. A characteristic of oncological and functional operability in patients of this group is given. More than half of them were elderly (41.9%) and senile (12.4%) patients. Radical operative interventions were thought to be possible in 161 patients (83.4%). Resections of the esophagus in combination with esophagogastro-or esophagoenteroplasty were performed in 146 of them. Resectability was 90.6%. Postoperative lethality was 9.9%. For the last 2 years resectability had increased up to 96%, while the postoperative lethality had decreased to 4%.

[The determination of the level of resection of the esophagus taking into account its blood supply]. / Opredelenie urovnia rezektsii pishchevoda s uchetom ego krovosnabzheniia.

Inadequate blood supply is one of the major reasons of esophageal anastomosis incompetence. The authors have examined esophageal blood supply as regards of the operative technique. The esophageal vascular system was studied by the method of intraarterial impregnation in 40 cadavers. Two segments, crucial for esophageal anastomosis, have been determined: retropericardial segment in case of the lower esophageal artery ligation and the upper segment of the thoracic esophagus in case of its extreme mobilization in proximal direction and ligation of lower thyroid arteries. The results of 175 operations were analysed. The direct correlation between the frequency of anastomotic incompetence and the level of its formation was determined. In the zone with an inadequate blood supply the complication occurred in 4 patients of 25 (16%). In other cases the rate of incompetence was 3.2%. No cases of incompetence were observed in 61 patients after anastomosis was performed with due regard for esophageal blood supply.

[The treatment of combined burn lesions of the esophagus and stomach]. / Lechenie sochetannykh porazhenii pishchevoda i zheludka.

In patients with an associated burn injury of the esophagus and the stomach, of determining significance is stenosis of the latter. Resection of the stomach is indicated in cases of subcompensated stenosis of the stomach with distinct boundaries of the scary damage. In parallel with the operation on the stomach for its stenosis, the formation of a gastrostoma of the proximal part of the organ should be also planned for the following bougienage of the esophagus by the directing thread.

[Resection of the esophagus with single-stage intrathoracic esophagogastroplasty]. / Rezektsiia pishchevoda s odnoétapnoi vnutrigrudnoi ézofagogastroplastikoi.

An experience with treatment of 152 patients with diseases of the esophagus who were subjected to resection of the esophagus with a one-step esophagoplasty is analyzed. A principally new approach is presented to the method of forming the gastric transplant, to choice of the level of the esophagus resection and to preoperative examination of the patients. Postoperative lethality was 9.9% with the complete absence of the esophageal anastomosis incompetence.

[The determination of the level of esophageal resection taking into account its blood supply]. / Opredelenie urovnia rezektsii pishchevoda s uchetom ego krovosnabzheniia.

The anatomical and polarographic investigations allowed the authors to establish two critical portions for forming the esophageal anastomoses. Risk of incompetence of the anastomoses in these portions is great because of an insufficient blood supply.

[A method of forming the gastric transplant for esophagoplasty]. / Metodika formirovaniia zheludochnogo transplantata dlia ézofagoplastiki.

A principally new method of forming the gastric transplant was developed on the basis of the anatomical investigation of the stomach blood supply, based on the intraorganic vascular way between 3 main collectors of the stomach--the right gastro-omental, left gastric and left gastro-omental arteries. The method was used in 65 patients operated upon with good results.

[Combined operations in stomach cancer]. / O kombinirovannykh operatsiiakh pri rake zheludka.

The authors make an analysis of their experience with the combined operations for gastric carcinoma in 108 patients. Lethality was 35,2%. Five-year survival was 19,6%. For such operations they recommend the thoraco-abdominal access or extensive transverse laparotomy.