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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.

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.

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.

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 (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.

Aim: To investigate early and remote results of surgery in patients with recurrent non-small cell lung carcinoma (NSCLC) after previous chemoradiotherapy alone., Material and Methods: The retrospective study included 14 NSCLC patients (10 men and 4 women, mean age 52.6 years) who were operated in thoracic department for the period June 2008 - December 2013. Histologically squamous cell carcinoma prevailed (64.3%). Prior to surgery stage IIB was diagnosed in 2 patients, IIIA in 11 and IIIB in 1 patient. The dose of radiotherapy ranged from 45 to 70 Gr (median 58Gr). The average number of chemotherapy cycles was 3.8 per patient. Pneumonectomy was performed in all patients except one who underwent left-sided lower lobectomy. In all cases bronchial stump was covered by vascularized muscle flap (intercostal, latissimus dorsi). Postoperative complications were classified by TMM system (Thoracic Morbidity and Mortality System)., Results: Postoperative complications were observed in 7 (50.0%) patients including level II in 2 cases, IIIA in 1 case, IVA in 3 patients and V (death) in 1 (7.1%) patient. Postoperative stages of lung cancer were IB in 2 cases, IIA in 1, IIB in 5, IIIA in 4 and IIIB in 2 patients. Overall 1, 2 and 3-year survival rate was 89.1%, 82.0% and 48.0% respectively (median 35.0 months). Recurrence-free survival was 84.2%, 72.0% and 24.8%, respectively (median 28.0 months). Overall and recurrence-free 5-year survival rate was 10.8%., Conclusion: «Salvage» surgery may be recommended as individual approach in patients with reccurent lung cancer after previous chemoradiotherapy.

Aim: Postoperative complications after pneumonectomy for NSCLC depend on the extension of surgery, comorbidities and accurate registration of any adverse event. The aim of the study was to evaluate the short-term results after standard and extended pneumonectomy in NSCLC patients according to the TMM grading system., Material and Methods: We included 216 NSCLC patients consecutively submitted to pneumonectomy at our institution from January 2009 to December 2013 in the retrospective study performed on data prospectively collected in an electronic clinical database. All patients were divided into two different groups: standard (n=142) and extended (n=74) pneumonectomy, where resection of adjacent organs was indicated. The patients undergone extended pneumonectomy were subdivided into single (n=49) and multi-organ resection (n=25) groups. Morbidity and mortality rate was analyzed according to the standard criteria and TMM classification system., Results: Postoperative morbidity and mortality rate after standard pneumonectomy (23,9% and 3,5%) was significantly lower than extended procedure (43,2% and 10,8%) (p=0.02). Multi-organ resection was an independent prognostic factor of unfavourable outcome: morbidity and mortality was significantly higher in the multi-organ group (48,0% and 16,0%), while in the single-organ group it was 40,8% and 8,2% respectively (p=0.01). Major complications rate (grade IIIA and higher according to the TMM) was significantly higher in the multi-organ group (40,0%) than in the single-organ (28,6%) and standard (14,8%) group (p=0.01)., Conclusion: TMM classification system is more accurate in grading and further analysis of postoperative complications after pneumonectomy in NSCLC patients in compare with standard criteria. Multi-organ resection should be carried out with caution due to unacceptable high morbidity and mortality rate.

Isolated bronchus resection for central cancer was performed in 25 patients including preoperative bronchoscopic removal of exophytic tumor in 20 (80%) observations in thoracic department of P. Gertsen Moscow Research Cancer Institute. According to morphological study typical carcinoid was diagnosed in 23 (92%) patients, atypical - in 2 (8%) cases. All patients underwent conventional mediastinal lymphadenectomy. Postoperative complications after bronchus resection developed in 6 (33.3%) patients. There were no deaths. Overall 5- and 10-year survival was 100% and 96% respectively. The authors consider that by strict indications combination of endoscopic removal with isolated bronchus resection preserves all pulmonary parenchyma without prejudice for surgical radicalism.

Results of treatment of 4970 patients with acute pancreatitis are presented. Acute destructive pancreatitis was seen in 572 (11.5%) cases. The disease severity was the basis of differential approach to treatment. Necessity of differential approach to choice of treatment policy is demonstrated. Mild and moderate acute destructive pancreatitis in the period of arising early postnecrotic aseptic complications requires combined conservative treatment, laparoscopic sanation and drainage of abdominal cavity and omental sac are indicated when peritoneal symptoms increase. Surgical treatment in patients hospitalized with mild and moderate acute destructive pancreatitis is indicated in early (on day 5-7 after the disease onset) and late (at least 2 weeks) postnecrotic septic complications requiring delayed and late miniinvasive and extended surgeries. Severe acute destructive pancreatitis in the period of developing early postnecrotic aseptic complications associated with severe endogenous intoxication, immunosuppression, polyorganic insufficiency is indication to early (the disease day 1-3) and delayed (day 5-7) surgeries, which are regarded as one of methods of surgical detoxication.