[Treatment of postoperative complications after surgery for esophageal cancer and cancer of the cardioesophageal junction]. / Lechenie khirurgicheskikh oslozhnenii posle operatsii pri rake pishchevoda i kardioézophagealnogo perekhoda.

Out of 108 patients with gastric and cardiac cancer and surgical complications, 49 were treated in the routine manner and 59 operatively. The immediate results were equal in either cases: 17 (34.7 +/- 6.8%) of 49 patients and 23 (39.0 +/- 6.35%) of 59 patients died (r = 0.46). However, to compare the results of two therapeutical policies is impossible: the magnitude of pathological changes and the severity of the patients' condition is too incomparable before a decision is made which therapeutical policy is chosen. The largest number of repeated emergency operations (22 patients) was associated with impaired hermiticity of the gastrointestinal tract. The major causes of this abnormality is esophageal anastomotic suture incompetence (2.7%) and graft necrosis (1.0%). Impaired patency in various parts of the gastrointestinal tract occupies the second place in its incidence (20 patients) for which 19 repeated emergency surgical interventions were made. Postoperative bleeding requiring repeated emergency surgical intervention occurred in 0.5%; in all cases, the bleeding was intrathoracic, chylothorax was detected in 1 patient, mediastinitis without disintegrity of the digestive tube was also noted in 1 patient, pancreonecrosis was recorded in 2 cases. Due to the introduction of extensive lymph dissection into these operations in 1990, the frequency of complications increased up to 2.1%.

Non-standard combination of radiation and surgery for esophageal cancer.

Three schemes of nonstandard combination of irradiation and surgery for esophageal cancer are presented: individual approach (IA), dynamic planning (DP), and sequential scheme (SS). In IA preoperative fractionation is adjusted to the tumor size. In DP esophageal resection is performed only in nonresponders to small-fraction 40-45 Gy radiation. In SS surgery is performed after radiation with greater than 50 Gy for residual esophageal tumor or reappearance of the tumor.

Surgery of localized cardioesophageal cancer.

In cardioesophageal cancer the 5-year survival was 52.5% for operations on patients without regional metastasis or involvement of the serous gastric membrane. When regional metastases were present, the 5-year-survival was 23.3%. When the whole wall was invaded with the tumor but there were no metastases to the regional lymph nodes, the 5-year survival increased to 38.2%. In cases involving both invasion and metastases, the percentage of 5-year survivors was 13.3%. These findings indicate the prognostic significance of metastatic spread to regional lymph nodes. When cardioesophageal tumor invasion spreads beyond the original tumor site, combined resection yields apparently similar results. The experience of this clinic permits us to conclude that potential progress in obtaining improved long-term results for esophageal cancer management is dependent on advances in lymph node dissection methods and the search for effective combinations of systemic treatment, involving chemotherapy or immunotherapy.

[Surgical and combined treatment of esophageal cancer]. / Khirurgicheskoe i kombinirovannoe lechenie raka pishchevoda.

The authors analyse 37-year experience in the treatment of patients with esophageal carcinoma by various methods at the All-Union Cancer Research Center. The immediate and long-term results of radiotherapy and surgical and combined treatment of 1,850 patients are shown. Bearing in mind the considerable extension of the neoplastic process by the time of the operation, the authors substantiate the expediency of one-stage operations with the formation of intrapleural esophagogastric anastomoses. The mortality in the recent years after 218 Lewis' operations and 36 Herlock's operations was 9.0%. After analysing experience in combined treatment, the authors failed to reveal any particular advantages over solely surgical treatment, but in view of the lack of other alternatives for improving the results of management of esophageal carcinoma to-date, they believe it expedient to continue study and improve various combinations of preoperative radio-(chemoradio)therapy and operation in large research centres.

[Computerized tomography in the surgery of esophageal cancer]. / Rentgenovskaia komp'iuternaia tomografiia v khirurgii raka pishchevoda.

Preoperative X-ray computerized tomography (CT) was performed in 60 patients with carcinoma of the esophagus at the All-Union Oncology Research Centre, USSR AMS in 1986-1989. The method is evaluated on the basis of comparison with the operative findings in determining the depth of invasion of the esophageal wall and adjoining structures by the tumor, metastatic involvement of the lymph nodes below the diaphragm, and metastases in the liver. Informativeness of X-ray CT proved to be highest in patients in whom the tumor had not spread beyond the esophageal wall. It was established that the method possesses high resolving possibilities in identification of enlarged lymph nodes in the abdominal cavity. Small metastases in the liver, measuring 0.5 to 2 cm in diameter, cannot be revealed by the method in some cases. The data gained by means of X-ray CT allows tactics of the surgical intervention to be determined and the late-term results to be predicted.

[Garlock's operation in cancer of the esophagus]. / Operatsiia Garloka pri rake pishchevoda.

Experience in 88 Garlock-type operations carried out in carcinoma of the esophagus allows a certain opinion to be formed on the advantages and shortcomings of this surgical intervention. In esophageal carcinoma with its proximal boundary within the range of the retropericardial segment of the esophagus, a left abdominothoracic approach (Garlock's operation) is adequate in resection of the esophagus in conformity with the oncological principles and allows the formation of the esophagogastric anastomosis at the level of the arch of the aorta without particular technical difficulties. Reduction of the time needed for the operation, determination of the resectability of the esophageal tumor before mobilization of the stomach are obvious advantages of the abdominothoracic approach.

[The combination of chronic lympholeukemia with other malignant neoplasms]. / Sochetanie khronicheskogo limfoleikoza s drugimi zlokachestvennymi novoobrazovaniiami.

Altogether 23 patients examined for secondary tumors at the All-Union Cancer Research Center of the USSR AMS underwent a clinical analysis. The overwhelming majority of the patients (17) were subjected to surgical intervention. Of these, none of the patients developed any postoperative complications or showed progress of chronic lympholeukemia (CLL). No relationship was noted between cytostatic treatment of CLL and origin of second tumors. No correlation was revealed either between the duration of CLL treatment and the incidence of second tumors origin. The authors provide a brief review of the literature on the given problem. Give a summary of the statistics of the CLL incidence in other malignant neoplasms.