Vol 16, No 4 (2011)

Surgical treatment was performed in 286 patients with lung cancer. The final morphological study diagnosed typical and atypical carcinoid tumors in 258 (90.2%) and 28 (9.8%) patients, respectively. The central and peripheral tumor sites were established in 245 (85.7%) and 41 (14.3%) patients, respectively. According to disease stage, the patients were distributed as follows: Stage I in 166 patients, Stage II in 84, Stage III in 30, and Stage IV in 6. Five (1.7%) patients were found to have carcinoid syndrome: the tumor had the morphological structure of atypical and typical carcinoid tumors in 3 and 2 patients, respectively. One patient with typical carcinoid was observed to have carcinoid syndrome concurrent with the Itsenko-Cushing syndrome. Two patients with carcinoid syndrome were ascertained to have hepatic metastases; these patients were recognized to be inoperable. The basic type of surgical intervention for typical carcinoid tumors was an organ-saving operation: lobectomy, bilobectomy, reconstructive plastic surgery, precision removal, and segmental resection. Only 7 patients underwent endoscopic removal of typical carcinoid tumors. In atypical carcinoid tumors, the surgical volume depends on the specific features of the extent of a tumor and the presence or absence of metastases. Pneumonectomy with lymphadenectomy and lobectomy in combination with and without bronchial resection were performed in half the cases. The long-term results of radical surgical treatment in patients with bronchopulmonary carcinoid tumors suggest that these operations are warranted.

A regimen was developed for the prevention of postoperative pyoinflammatory complications in patients with lung malignancies. Russian antioxidants and immunomodulators, such as laprot (L), ceruloplasmin (C), imunofan (I), and galavit (G), were used for corrective therapy. The trial was conducted in the randomized groups of patients: 24 patients were treated with a regimen of C+G, 31 received L+I, 28 patients had L+G, 18 had C+I; and 47 patients made up a control group. The study has demonstrated that corrective therapy, particularly that including the immunomodulator imunofan and the antioxidants ceruloplasmin or laprot, decreases the frequency and severity of postoperative pyoinflammatory complications.

The investigators conducted a preclinical study of the antitumor efficacy of the combined use of an Oxycobalamin-lio (Ox-lio) + Efiter acid-based binary catalytic system (BCS) with radiation and chemoradiation therapy. The incorporation of the BCS Ox-lio + ascorbic acid (Aa), which was used as independent antitumor agents, into a chemoradiation therapy regimen, was shown to lead to biologically important tumor growth suppression throughout the observation and to promote the potentiated therapeutic effect of radiation/chemotherapy. The therapeutic effectiveness of the Ox-lio + Aa BCS used as a modifier is higher than the Efiter + Ac BCS, which seems to be due to its detoxifying activity. The findings suggest the expediency of a clinical trial of the Ox-lio + Ac BCS as a modifier of medical treatments in patients with malignancies.

The level of a serological marker for squamous cell carcinomas (SCC) was studied in patients with primary, remitting, and relapsing esophageal SCC (ESCC). The levels of SCC antigen (SCCA) increased from Stage I to Stage IV (from 0.8±0.3 to 1.7±0.3 ng/ml, so as the percentage of patients with elevated SCCA (from 20 to 60%, respectively). In remission, the values of SCCA were within the upper normal range in all the patients. The diagnostic sensitivity of SCCA in relapse was similar to that in primary SCC (38/9 and 39.8%, respectively). The proportion of SCCA-positive cases was higher in patients with low- and moderate-grade tumors than in those with high-grade tumors (54.1 and 21.4% of cases, respectively). The mean level of SCCA slightly rose after invasive diagnostic procedures. Hence, this group of patients should undergo serum SCCA tests before and 3-4 days after invasive diagnostic procedures. For the monitoring of the efficiency of treatment and preclinical detection of relapses, it is expedient to use SCCA as a serological marker in 30-40% of all patients with primary ESCC and in approximately 50% of patients with low- and moderate-grade SCC.

The paper considers the state-of-the-art of the problem of lung carcinoids. Particular emphasis is laid on the treatment of patients with typical carcinoid tumors. Most patients undergo organ-saving bronchoplastic procedures, including isolated bronchial resection with interbronchial anastomosis and preservation of the whole lung parenchyma. The paper describes a case of the rare operation to make polybronchial anastomosis.

The paper reviews the literature concerning the surgical treatment of patients with non-small-cell lung cancer. It describes the historical aspects of development of lung surgery and the views about mediastinal lymphadenectomy. The long-term results of treatment in this group of patients are given in terms of tumor stage and morphological structure. The major and additional prognostic factors influencing 5-year survival after surgical treatment are identified and specified.