Experience of tracheo-bronchoplastic surgery for lung cancer

Introduction. Currently, surgical treatment of lung cancer is impossible without the use of tracheobronchoplastic operations, which in advanced specialized clinics take up to 5-10% of all radical operations. Material and methods. We conducted a retrospective study including 21 patients with centrally located lung cancer who underwent 22 tracheobronchoplastic radical operations between 2000 and 2021. The operated patients included 18 men and 3 women aged 42 to 67 years (mean age 54.5 ± 12.5 years). The morphological structure of the tumors was represented by carcinoid (2) and squamous cell carcinoma (19). The pathological process was located in the right lung in 16 patients and in the left lung — in five patients. Comorbid status was present in 20 patients. Standard lateral thoracotomy was used in 18 cases, and video-assisted minithoracotomy — in three cases. Extended lymphodissection up to D2 was performed in all surgeries. Combined surgeries included resection of adjacent organs: pericardium (2), unpaired vein (2), superior vena cava (1), diaphragmatic and vagus nerves (1), pleura (1). Results. The average duration of operations was 242.3 minutes (125-345 minutes), the average blood loss was 283.2 ml (50–1000 ml). Complications developed in 5 (22.7%) patients. Mortality was observed in 2 (9.1%) cases. Conclusion. The use of tracheobronchoplastic operations significantly expands the possibilities of thoracic surgery in treatment of lung cancer both due to technical resectability of the tumor at the transition to the main bronchus and trachea and due to functional operability at low respiratory functions and impossibility to perform pneumonectomy.

Comprehensive approach to choosing surgical tactics for locally advanced forms of colorectal cancer in patients of older age groups

The objective is to improve the results of treatment of locally advanced colorectal cancer in patients of older age groups due to the personalized approach to choosing surgical tactics with a comprehensive assessment of the functional operability and molecular biological properties of the tumor.Material and methods. A comparative evaluation of the results of surgical treatment of locally advanced colorectal cancer in patients of different age groups was conducted on representative clinical material. We studied the molecular profile of tumors, taking into account the age factor, and the clinical significance of specific markers in predicting the results of treatment.Results. The most significant indicators of functional operability of patients that must be considered when choosing a surgical tactic were identified. . The features of the immunophenotype of tumors, taking into account the age factor, were determined; and the prognostic significance of specific immunohistochemical indicators was estimated.Conclusion. The use of a personalized approach to choosing surgical tactics allows to achieve encouraging results of treatment in geriatric patients with locally advanced colorectal cancer.

Risikoeinschätzung einer operativen Therapie des Bronchialkarzinoms mit Hilfe der quantitativen Lungenperfusionsszintigraphie

28 patients with bronchogenic carcinoma were studied to predict lung function after thoracic resectional surgery, i.e. the functional operability, employing preoperative vital capacity (VC), forced expiratory volume (FEV1) and perfusion lung imaging. The perfusion scan was divided into 12 regions of interest which were semiquantitated to determine the relative distribution of perfusion as a fraction of the total perfusion. The planned reduction of lung parenchyma was expressed as percent of total perfusion, and the expected decrease in VC and FEV1, i. e. the predicted postoperative function of the lung, was calculated. The comparison of the predicted functional lung capacity with the re-estimated lung function (VC and FEF1) 6 months after surgery showed high correlation coefficients for both VC and FEV1. Semiquantitative perfusion scintigraphy of the lung helps to determine the extent of surgery possible in the individual therapy of lung cancer and is especially important in patients with a high operative risk.