Search

The methods of performing lymphodissection in various diseases are analyzed. The experience of more than 20 interventions in 9 examinations combining the radical removal of the primary tumor with the aortocoronary by ass surgery is described. The combination of comprehensive operations with subsequent hyperthermic intraperitoneal chemotherapy should be considered as one of the most promising lines in the treatment of the locally widespread and disseminated abdominal cavity tumors. It is emphasized that the surgical intervention is the basic treatment component of any one of the epithelial malignant tumor of the thoracal and abdominal localization and the integration of widespread interventions with the additional effect on tumor cells based on the current scientific achievements.

Objective: to evaluate the outcomes of thrombectomy performed using different surgical techniques in renal cell carcinoma (RCC) patients with extensive tumor venous thrombosis.Materials and methods. This study included 345 RCC patients with extensive tumor venous thrombosis who underwent surgical treatment.The median age was 57 years (range: 16—79 years); the male-to-female ratio was 1:1.9. Two hundred and sixty patients (75.4 %) had their tumor thrombus originating from the right renal vein, 85 patients (24.6 %) — from the left renal vein. In 169 patients (49.0 %), the thrombus spread to the retrohepatic inferior vena cava (IVC), while in 176 patients (51.0 %), it spread above the diaphragm (to the intrapericardial IVC in 59 patients (17.1 %) and to the right heart cameras in 117 patients (33.9 %)). Regional metastases were found in 90 individuals (26.1 %), while distant metastases were observed in 124 patients (35.9 %). All patients underwent surgical treatment (radical in 251 patients (72.8 %) and cytoreductive — in 94patients (27.2 %)); the technique of vascular control and circulatory support was chosen individually. In 97 patients (28.1 %), the control over the cranial thrombus boarder did not require opening of the chest cavity; eleven patients (3.2 %) were operated on with cardiopulmonary bypass.Results. The median surgery time was 215 minutes; the median blood loss was 4500 mL. Intraoperative complications were registered in 209 patients (60.6 %) and postoperative complications were observed in 118 patients (35.1 %) (including those of grade I—II in 43 individuals (12.8 %) and grade III—V in 75 individual (22.3 %)). The in-hospital mortality rate was 10.7 % (37/345). At a median follow-up of 32.3 months, overall and diseasespecific survival rates among all patients were 51.9 % and 68.3 %, respectively; relapse-free survival rate in 226patients who have undergone radical surgeries and discharged from the hospital was 61.5 %; progression-free survival rate in 82 patients who have undergone cytoreductive surgery was 33.0 %. The method ofIVC control and circulatory support had no effect on both short-term and long-term treatment outcomes (p >0.05 for both).Conclusion. The use of minimally invasive techniques of vascular control and avoidance of cardiopulmonary bypass in carefully selected RCC patients with extensive tumor venous thrombosis do not worsen the outcomes of nephrectomy and thrombectomy.

Purpose: we reviewed the outcome of surgical treatment of 165 patients with renal cell carcinoma (RCC) invading venous system.Materials and methods: 3187 patients with RCC were seen at our institution between 1971 and 2004. The vascular extension (stages T3b-T3c) was present in 299 (9,3%) cases. Of 299 patients 82(27,5%) were not considered for surgery, 52(17,3%) underwent palliative nephrectomy and 165(55,2%) underwent radical surgery including radical nephrectomy with thrombectomy. The latter group was retrospectively analyzed. Of 165 cases the tumor thrombus was confined to the renal vein in 58 (35,2%). In patients with IVC involvement 28 (17%) had perirenal, 39(23,6%) subhepatic, 16(9,7%) retrohepatic and 24 (14,5%) — suprahepatic types of tumor thrombi. The surgical technique varied according to the level of tumor thrombus.Results: The complete removal of primary tumor and venous thrombus was possible in 147 of 165 cases. The histology showed organ-confined tumor in 93 (56,4%) cases. The perirenal fat invasion was present in 66 (40%) and was not assessed in 6 cases. Histology report confirmed the diagnosis of renal cell carcinoma in all patients. The tumor grade occurred to be G1 in 5(3%), G2 — in 52(31,5%), G3 — in 53 (32,1%) and was not mentioned in the histology report in 55 (33,3%) cases. Regional lymph-nodes were positive (pN+) in 29 (17,6%), clear in 131 (79,4%) and not assessed in 5(3%) cases. Distant metastasis were found in 21(12,7%) and were not properly assessed in 5 (3%) patients. Major intra and postoperative complications occurred in 16,3% of cases with the mortality rate of 3,6% (6 patients). Overall 3, 5 and 10 year survival of 165 patients was 58,5%, 46%, and 25% respectively with a median survival of 52 months. Five factors including perinephric fat invasion, presence of lymph node and distant metastasis, poor tumour differentiation and not radical surgery proved to significantly worsen the survival in univariable analysis. Moreover, overall 3,5 and 10 year survival of the patients who did not have these adverse factors, was found to be significantly better — 72%, 62% and 31% respectively. In multivariable regression (Cox stepwise) analysis only 2 factors — the presence of lymph node metastasis and completeness of the surgery influenced the survival.Conclusions: Although the presence of venous invasion worsens the prognosis of patients with RCC radical surgery gives the chance for cure and long-term survival. With new drug development stratification of patients according to their prognosis could be beneficial.

As high as 40% of patients have locally advanced pelvic tumors without distant metastases and many of them have previously undergone radical treatment. The only possible treatment for these patients is combined and expanded surgery.Subjects and methods: In 1996 to 2004, a total of 38 patients with locally advanced pelvic tumors involving the bladder underwent different types of evisceration at the Department of Radiosurgery, Russian Cancer Research Center. There were internal fistulas in 18 cases. Total evisceration was performed in 4 (10.5%) patients, subtotal supralevator evisceration in 25 (65.8%), subtotal infralevator evisceration in 3 (7.9%), and frontal evisceration in 6 (15.8%) patients. Thirty-one (81.6%) patients underwent ureteral reconstruction without ureterostomy; normal stool restored in 35 (92.1%) patients.Results: One (2.6%) patient died intraoperatively. Twenty-eight patients had postoperative complications that needed resurgery in 12 cases. Three patients with the single-stage ileal orthitopic bladder reported that they had a fair urinary retention. One patient complained about nocturnal urinary incontinence. Stool retention was fair in all cases.Conclusion: Careful selection of patients, comprehensive preoperative preparation, and improved surgical performance will reduce the incidence of postoperative complications.

Objective. To evaluate short-term and long-term results of nephrectomy, thrombectomy, circular inferior vena cava (IVC) resection in patients with renal cell carcinoma (RCC) and advanced IVC tumor invasion. Materials and methods . Medical data of 49 patients with RCC and level II–IV tumor venous thrombus with advanced IVC wall tumor invasion were analyzed. All the patients underwent nephrectomy, thrombectomy, circular IVC resection (radical – 35 (71.0 %), cytoreductive, in M+ cases – 14 (28.6 %)). Circular resection of the infrarenal IVC segment was performed in 25 (51.0 %) patients; resection of the infrarenal, perirenal and retrohepatic IVC segments with a ligation of the left renal vein (RV) – in 24 (49.0 %) patients. Perirenal IVC prosthesis was used in 2 (4.1 %) patients with initially preserved IVC blood flow, in other cases replacement of the removed IVC segment wasn’t performed due to presence of a network of venous collaterals duplicating the IVC. Patients with metastases received systemic antitumor treatment after nephrectomy, thrombectomy. Results . Median operative time was 260 (135–580) minutes, median blood loss was 8750 (3000–27 000) ml. Severe intraoperative complications were observed in 2 (4.0 %) patients, 1 (2.0 %) patient died on the operating table due to hypovolemic shock. Postoperative complications were observed in 26 (53.2 %) cases (grade III–V in 22 (45.8 %) patients). Five-year overall and cancer-specific survival of all patients was 54.6 and 67.8 %, respectively, relapse-free survival of 35 patients with M0 category was 49.4 %. Both IVC prostheses were patent 12 months after the surgery. Function of the left kidney after ligation of the left RV was preserved at the preoperative level in all 24 patients in a median of 12 (2–120) months. Conclusion. Nephrectomy, segmental/subtotal cavectomy with preservation of the main renal venous entries is an effective treatment method in RCC patients with advanced tumor IVC invasion. The method allows to achieve satisfactory long-term survival rates and functional results.

This article deals with a new class of nitric oxide donors—safe medications for the treatment of socially significant diseases. This complex work has been performed in collaboration with a number of RAS institutes, the Russian Cardiology Research and Production Complex, and the Blokhin Russian Cancer Research Center.

Tamoxifen is the first target agent with a high-end position in breast cancer therapy till now. In recent years experimental researches revealed new biological effects of tamoxifen on tumor cells. The present study continues the theme of the review published in 2012, where a plenty of tamoxifen effects besides interaction with estrogen receptors was discussed. Thus, there is described a wide range of the drug targets which are the key points of signal cascades activating the cell proliferation and determining the course of the growth of the cancer and its sensitivity to chemotherapy. Also clinical trials of tamoxifen based on existing of targets besides the estrogen receptors are reviewed. Furthermore, the data on the antiviral, antibacterial, antifungal and antiparasitic activities of tamoxifen are indicated.

To present early and remote surgical outcomes in patients with locally-advanced right-sided colonic cancer, invasion of pancreatic head and/or duodenal wall.Early and remote surgical outcomes were analyzed in 27 patients who underwent gastropancreatoduodenectomy combined with right-sided hemicolectomy (ileotransversostomy extirpation) for locally-advanced right-sided colonic cancer.Mean time of surgery was 300 (240-460) minutes, intraoperative blood loss - 2000 (500-7200) ml. Postoperative complications were observed in 15 (55.6%) patients. 3 (11.1%) patients died in early postoperative period. Overall 1-, 3- and 5-year survival was 92.7%, 48% and 36,5% respectively. Median was 33 months.Advanced combined surgery for locally-advanced right-sided colonic cancer, invasion of pancreatic head and/or duodenal wall is associated with acceptable incidence of postoperative complications, early and long-term mortality.Цель - представить непосредственные и отдаленные результаты хирургического лечения больных местно-распространенным раком правой половины толстой кишки с вовлечением головки поджелудочной железы и/или стенки двенадцатиперстной кишки. Материал и методы. Проанализированы непосредственные и отдаленные результаты лечения 27 больных, которым выполнена гастропанкреатодуоденальная резекция в сочетании с правосторонней гемиколэктомией (экстирпацией илиотрансверзоанастомоза) по поводу местно-распространенного рака правой половины толстой кишки. Результаты. Медиана продолжительности оперативного вмешательства составила 300 мин (240-460 мин). Медиана объема интраоперационной кровопотери была на уровне 2000 мл (500-7200 мл). Послеоперационные осложнения диагностированы у 15 (55,6%) больных. В раннем послеоперационном периоде умерли 3 (11,1%) больных. Общая 1-летняя актуариальная выживаемость в рассматриваемой группе составила 92,7%, 3-летняя - 48%, 5-летняя - 36,5%. Медиана 33 мес. Вывод. Выполнение расширенных комбинированных оперативных вмешательств больных местно-распространенным раком правой половины толстой кишки с вовлечением головки поджелудочной железы и/или стенки двенадцатиперстной кишки позволяет получить приемлемых показателей выживаемости в отдаленные сроки, с приемлемым уровнем послеоперационных осложнений и летальности.

Objective: to identify the predictors of perioperative complications and deaths in surgically treated patients with kidney cancer complicated by venous tumor thrombosis.Subjects and methods. The investigation included data on 463 kidney cancer patients with venous tumor thrombosis. The patients, median age was 57 years. The male / female ratio was 2.5:1. Perirenal, subhepatic, retrohepatic, and supradiaphragmatic tumor thrombi were diagnosed in 161 (34.8 %), 135 (29.2 %), 82 (17.7 %), and 85 (18.3 %) patients, respectively. Regional and distant metastases occurred in 90 (19.4 %) and 145 (31.3 %) cases, respectively. All the patients underwent thrombectomy, retroperitoneal lymphadenectomy; a tumor-affected kidney was removed in 452 (97.6 %) patients.Results. Median surgery duration was 259 (30–580) min; median blood loss was 3500 (100–27 000) ml. The incidence of intraoperative complications was 24.6 % (114 / 463); mortality was 0.9 % (4 / 463). The independent risk factors of intraoperative complications were cranial margin of a tumor thrombus (odds ratio (OR) 1.9; 95 % CI 1.4–2.6; p < 0.0001) and circular resection of the inferior vena cava (OR 5.8; 95 % CI 1.2–27.8; p < 0.0001). The incidence of postoperative complications was 25.7 % (118 / 459);mortality was 6.0 % (28 / 459). Resurgery was required in 31 (6.8 %) cases. Regression analysis identified the risk factors of postoperative complications (highly located cranial thrombus margin (OR 2.6; 95 % CI 1.1–6.4; p = 0.037) and lactate acidosis (OR27.1; 95 % CI 1.2–613.1; p = 0.038), postoperative death (hepatic vein thrombosis (OR 15.6; 95 % CI 4.5–54.3; p < 0.0001),lactate acidosis (OR 23.1; 95 % CI 3.4–158.4; p = 0.001) thrombus removal from the heart (OR 5.0; 95 % CI 2.1–12.2; p < 0.0001)),perioperative death (cranial thrombus margin (OR 1.9; 95 % CI 1.2–3.2); р = 0.007), contralateral renal vein thrombosis (O R 4.4;95 % CI 1.2–15.8; p = 0.025), lactate acidosis (OR 28.4; 95 % CI 4.9–165.1; p < 0.0001), and low creatinine clearance (OR 4.6;95 % CI 1.9–24.9; p = 0.017).Conclusion. Thrombectomy in patients with T3a–cNxMx kidney cancer is a technically difficult intervention associated with the high incidence of complications and death, which must be performed only in specialized centers. The identified risk factors may serve as criteria for predicting the results of thrombectomy.

The problems of using physical research methods in diagnostics of oncological diseases of the gastrointestinal tract and constructing a multimedia learning system on their basis for doctors are considered. The system includes: expert systems, a remote learning system, and an electronic textbook. Disease localizations in esophagus, stomach, intestines, pancreas, and liver are considered. Practical application of the system provides an increase in the learning efficiency during postgraduate training of oncologists and their advanced training.

Gastric cancer, one of the most widespread malignant tumors, still lacks reliable serum/plasma biomarkers of its early detection. In this study we have developed, unified, and tested a new methodology for search of gastric cancer biomarkers based on profiling of low molecular weight proteome (LMWP) (1-17 kDa). This approach included three main components: sample pre-fractionation, matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF-MS), data analysis by a bioinformatics software package. Applicability and perspectives of the developed approach for detection of potential gastric cancer markers during LMWP analysis have been demonstrated using 69 plasma samples from patients with gastric cancer (stages I-IV) and 238 control samples. The study revealed peptides/polypeptides, which may be potentially used for detection of this pathology.V nastoiashchee vremia otsutstvuiut nadezhnye biomarkery syvorotki/plazmy krovi dlia rannego obnaruzheniia raka zheludka (RZh) – odnoĭ iz naibolee rasprostranennykh zlokachestvennykh opukholeĭ. V dannom issledovanii razrabotana, unifitsirovana i aprobirovana novaia metodologiia poiska biomarkerov RZh – profilirovanie nizkomolekuliarnogo proteoma (NMP) plazmy krovi (1-17 kDa). Dannyĭ podkhod vkliuchal tri osnovnykh komponenta: predvaritel'nuiu podgotovku obraztsov, vremiaproletnuiu mass-spektrometriiu s matrichno-aktivirovannoĭ lazernoĭ desorbtsieĭ/ionizatsieĭ (MALDI-TOF-MS), obrabotku dannykh s pomoshch'iu bioinformatsionnogo paketa programm. Prodemonstrirovany vozmozhnosti i perspektivnost' razrabotannogo podkhoda dlia obnaruzheniia potentsial'nykh markerov RZh pri analize NMP 69 obraztsov plazmy krovi bol'nykh RZh (I-IV stadii) i 238 kontrol'nykh obraztsov. V rezul'tate provedennogo issledovaniia obnaruzheny peptidy/polipeptidy, kotorye mogut v perspektive ispol'zovat'sia dlia detektirovaniia étoĭ patologii.

Случай из практики

The system approach to the development of intellectual complexes in cancer diagnosis are discussed in the article. Distinctive features of this approach: the participation of pathologist at the stage of description of recognizable images (the description is based on traditional assessments of quality informative features of tumors); the set of the most similar probabilistic diagnoses is forming on the classification stage of recognition; final histological diagnosis is made by pathologist. The proposed approach has been successfully tested in clinical practice. Keywords: image processing, image description, image classification, pattern recognition, qualitative attributes of tumor images, interactive recognition, cancer diagnosis, decision support system

The reasonability of SMLD in lung carcinoma when compared with resection of enlarged lymph nodes only has been widely discussing in literature. This study was aimed to define the tumour extent and to improve results of surgical treatment of NSSLC applying the "extended" surgical interven tion (with SMLD) as a standard. The study analyzed short term and long term outcomes in 1109 NSSCL patients of 18 to 80 yrs old who were oper ated at the Russian Oncology Scientific Centre in 1980 to 1999. Of the total number of surgical interventions, 417 (37.6 %) were "extended" and 692 (62.4 %) were typical. In the "extended" surgery group, 86 (44.6 %) of the patients had NSSLC stage I, 144 (35.5 %) had the stage II and 87 (20.9 %) had the stage IIIA; in the "typical" group, there were 429 (62 %), 146 (21.1 %) and 117 (16.9 %) patients, respectively. The total survival was significantly higher in the SMLD group (p = 0.03). The 3 year survival and the 5 year survival was 65 % and 55 % after the extended surgery and 54 % and 43 % after the typical surgery, respectively.The tumour relapse in the bronchial stump in 6.2 %, metastases at the mediastinal lymph nodes in 8.7 % and at the supraclavicular lymph nodes in 1.7 % were found in the typical surgery group. These parameters in the extended surgery group were 1.9 %, 3.6 % and 0.9 %, respectively (p < 0.05). Thus, the SMLD technique improves long term results of surgical treatment of NSSLC stages I, II and IIIa. It decreases the rate of local relapses of the tumour and does not increase the rate of post surgery complications and mortality. This type of surgical intervention is thought to be the standard surgical treatment of lung carcinoma and has to be performed in all the patients despite of the tumour size, hystological, clinical and anatomical type and of its location in the lung.

It was operated 17 patients with kidney and bladder cancer against the background of severe concomitant coronary artery disease (52.9%), aortic aneurysm (35.3%) or combination of coronary artery disease with Leriche syndrome (5.9%) or hemodynamically significant stenosis of internal carotid artery (5.9%). Patients were operated for the period from 1998 to 2012. All patients were male at the age from 39 to 80 years (mean 62.1 years). The first stage of kidney cancer was diagnosed in 8 (53.3%) patients, the second stage - in 1 (6.7%) patient, the third stage - in 2 (13.3%) patients and the fourth stage was observed in 4 (26.7%) patients. Bladder cancer had 1 and 2 stages. Simultaneous operations were performed in 3 (17.6%) patients. 12 (70.6%) patients were operated consequentially. Surgery for kidney cancer was not done in 2 (11.8%) of 17 patients because of patient death after coronary bypass surgery or patient refusal of surgery after carotid arteries stenting. Intraoperative and postoperative complications have been developed in 9 (52.9%) of 17 patients. 2 (11.8%) patients died. The complications frequency and mortality after simultaneous operations were 25% (1 of 4) and 0. These parameters were 57.1% (8 of 14) and 14.3% respectively in case of consequent tactics. It was not observed myocardial infarction and aortic aneurysm rupture after surgeries for kidney and bladder cancer. Overall 1, 3, 5 - year survival of patients with kidney cancer and severe concomitant cardiovascular diseases was 100%, 73.3% and 52.4% respectively. It was concluded that surgical treatment of severe concomitant coronary artery disease and aortic aneurysm in patients with kidney and bladder cancer decreases risk of myocardial infarction and aortic aneurysm rupture in intraoperative and postoperative periods.

The aim of the review was systematization of the data on discordance in expression of estrogen receptors between primary and metastatic breast cancer, different metastases and repeated analyses of the same tissue. The possible reasons for the phenomenon are discussed. The authors emphasize the need to analyze estrogen receptors in breast cancer metastases, regardless of the receptor status of the primary tumor, for predicting the course of the metastatic disease and providing an adequate treatment of the metastatic tumor in strict accordance with its receptor status during drug therapy. The works cited in the search engine Pub Med to May 2013 were analyzed.

Анализ заболеваемости и смертности от злокачественных новообразований имеет важное значение для определения потребностей населения в онкологической помощи и разработки перспективных планов целенаправленного производства оборудования и противоопухолевых средств, специальной подготовки кадров, а также для всего комплекса противораковых мероприятий.Изучение изменений в частоте, структуре и особенностях распространения онкологических заболеваний в различных популяциях и на отдельных территориях, а также оценка обобщенных критериев состояния здоровья населения дает необходимую информацию для планирования лечебно-профилактических мероприятий на государственном и региональном уровнях, способствуя совершенствованию онкологической помощи больным злокачественными новообразованиями ЖКТ.

Несмотря на стабильное снижение заболеваемости и летальности, рак желудка (РЖ) по - прежнему остается крайне актуальной проблемой человечества. В отделении торако-абдоминальной онкологии РОНЦ РАМН выполнен анализ непосредственных и отдаленных результатов лечения больных раком тела и проксимального отдела желудка. Все изложенные факты позволяют рассматривать расширенные операции в объеме D2 как стандартные вмешательства в хирургическом лечении РЖ. После отработки методологии выполнения расширенных операций и тактики ведения послеоперационного периода целесообразным следует считать проведение проспективных рандомизированных исследований в достоверных группах больных с целью выявления преимуществ и недостатков различных вариантов расширенных и расширенно - комбинированных операций.

Низкая чувствительность рака пищевода (РП) к существующим химиотерапии, паллиативный и кратковременный эффект лучевой терапии делают хирургический метод основным в лечении больных раком пищевода.С целью обоснования целесообразности выполнения расширенной лимфодиссекции шейно - надключичной области, средостения и забрюшинного пространства мы изучали особенности и частоту лимфогенного метастазирования рака внутригрудной локализации. Выполнение расширенной лимфодиссекции не только улучшает отдаленные результаты лечения, но и позволяет правильно определить истинную распространенность процесса.

The metabolism of14C-arachidonic acid in cell-free homogenates of 65 primary, primary multiple, and metastatic tumors of human lungs is studied. The biosynthesis of arachidonic acid lipoxygenase metabolites 12-and 15-hydroxyeicosatetraenic acids is suppressed in all metastatic tumors.

46 year old man appealed to the Cancer Research Center of RAMS in October 2012 with unverified anterior superior mediastinal tumor, which was diagnosed in 2010. Progressive compartment syndrome of the superior vena cava was observed. On examination: CT, MRI, angiography, histological and cytological examination of biopsy material did not allow to confirm the morphological structure of the tumor. Removal of the tumor with bifurcation of the brachiocephalic trunk prosthetics was performed. Immunohistochemical (IHC) study verified malignant hemangioendothelioma.

51 patients with gastric cancer and severe concomitant ischemic heart disease (90.2%), valvular heart disease (5.9%), critical stenosis of the internal carotid artery (2%) or abdominal aortic aneurism (2%) were operated on during 1995-2011yy. Of them men were 41, women - 10; mean age was 65.1 years (51-82). The first stage of gastric cancer was diagnosed in 18 (35.3%) of patients, second, third and fourth in 12 (23.5%), 17 (33.3%) and 4 (7.8%), respectively. Radical tumor resection was achieved in 37 (72.5%), palliative operations were performed in 13 (25.5%) patients. 17.6% of patients were operated on stomach and vessels simultaneously. 82.4% received the stepwise treatment. Intra- and postoperative complications were registered in 47.1% (24 of 51 patients); of whom 5.9% (3 patients) ended lethally. Simultaneous operations showed the 55.6% complications and zero lethality rate, whereas stepwise treatment resulted in 45.2% complications and 7.1% lethality.

During the period of 1991--2010 yy 51 patients with lung cancrs were operated on the severe cardiovascular diseases (IHD -- 90%; critical carotid stenosis -- 6%; tricuspidal valve failure -- 2% and the combination of the IHD and aortic valve failure -- 2%). Lung cancer steged I in 17 (33.3%) patients, II in 15 (29.4%); III - in 16 (31.4%) and IV in 3 (5.9%) patients. 33 patients of 51 were radically operated on lung cancer, palliative resections were performed in 3; trial thoracotomies were performed in 2 patients. 8 (15.7%) patients were operated on simultaneously. The complicated postoperative period was registered in 22 (57.9%) patients of 38 with exitus lethalis in 2 cases. The complication rate after simultaneous operation was 62.5% with lethality of 12.5%, whereas by the consecutive operations the complication rate was 56.7% with lethality of 3.3%, Nevertheless, surgical correction of the severe concurrent cardiovascular pathology flares the range of operable patients with lung cancer.

Experimental studies showing ever new biological effects of tamoxifen on tumor cells, both expressing and nonexpressing estrogen receptors, are providing a novel conception of the drug, likely well known at present. The review describes tamoxifen targets, whose blocking induces inhibition of tumor cell growth and angiogenesis, stimulation of the programmed cell death (apoptosis, autophagia and necrosis), inhibition of multiple drug resistance mechanism and inhibition of invasion and metastasizing. In all the events, the results of the tamoxifen interaction with the cells are prognostically favourable from the viewpoint of both the inhibition of the tumor growth and metastasizing and the susceptibility to the medicinal therapy, that is considered by some authors as an extremely important addition to the tamoxifen antiestrogenic effect. The strategy of long-term tamoxifen adjuvant therapy of breast cancer with positive status of the estrogen reseptors was developed by Craig V. Jordan as far back as in the seventies of the XXth century, however there are arguments allowing to consider it also useful for the treatment of other tumors. First of all it is the fact described lately in regard to expression of estrogen beta-reseptors in solid tumors of practically all known localization and histological types, that are also the targets of tamoxifen. Apart from estimation of estrogen receptors, it is believed by some authors that molecular and biological choice of patients is necessary with an account of expression of other cell targets of antiestrogen for complete realization of all the aspects of tamoxifen biological activity in long-term adjuvant therapy of malignant tumors of various localization.

Literature review upon various types of estrogen receptors expression (type alpha and beta) in the cells of cellular lung cancer, their participation in estrogen and antiestrogen effects implementation, influence of estrogens and antiestrogens on occurrence and progression of malignant lung tumors in animals and humans. Were analyzed reasons of data ambiguity on type beta estrogen receptors (ERbeta) expression frequency. The results of authors own research in quantitative assessment of ERbeta expression in tumor tissue of patients with cellular lung cancer (79 male and 22 female patients are presented in this article. An increase in expression rate and incidence of tumors with high ERbeta level has been shown in patients with lung adenocarcinoma regardless of smoking status or gender. A new strategy of antiestrogen use, especially tamoxifen, has been formulated for cellular lung cancer treatment. Authors believe in a positive effect of adjuvant treatment with tamoxifen in patients with ERbeta-positive cellular lung cancer used independently or during and after the chemotherapy, by analogy with breast cancer patients.

The study was designed to analyse results of D1- and D2-lymphodissection in 394 patients with early stomach cancer between 1990-2007. Risk factors of lymphogenic metastasis (lymphatic invasion, submucous invasion, tumour size in excess of 4 cm, venous invasion, tumour spread to the oesophagus, type 0I and 0II tumors, poor differentiation) are considered to be an absolute indication for D2-lymphodissection that allows to significantly reduce the frequency of relapses and improve the outcome of surgery. The restriction of surgery volume to D1-lymphodissection is possible only in patients with negligibly low risk of metastasis regardless of the type of early cancer.

36 patients were operated on lung cancer (30), trachea (1), lung colon cancer metastases (1), left atrium paraganglioma, bronchogenic thymic cyst (1) and lung tuberculoma (2). Competing cardio-vascular diseases were as follows: coronary heart disease (30), valve failure (3) and critical stenosis of internal carotid artery (3). Simultaneous operations were performed in 13 (36.1%), consecutive - in 23 patients. Non-complicated postoperative period was registered in 19 patients. 6 of them had simultaneous surgery and 13 were operated on consecutively. Overall mortality rate was 8.3%; among patients operated on simultaneously it was 15.4%, among patients of the second group - 4.3%. There were no postoperative deaths among patients, operated first on cardio-vascular system.

A review of the literature data on expression of estrogen receptor alpha and beta (ERalpha and ERbeta) in tumors different from breast cancer. The results regarding the ERalpha and ERbeta expression frequency in non-small cell and small cell lung cancer, colorectal cancer, esophageal, ovarian, prostate and brain tumors are presented. High frequency of estrogen receptor expression (in up to 50 and more per cent of cases) in various types of tumors, differences between ERalpha and ERbeta in expression frequency, prognostic significance and prediction of the neoplastic process aggressiveness as well as in biological implications of interaction with antiestrogens (antagonistic and/or agonistic effect) are shown. The data on comparative evaluation of ERalpha and ERbeta expression in lung, ovarian, prostate tumor cells and corresponding nonneoplastic tissues are reported. Authors consider necessary to include the ERalpha and ERbeta detection into the routine clinical practice not only in breast cancer but in other tumors as well. Prospects of the clinical application of antiestrogens, in particular tamoxifen, in adjuvant therapy of different tumors with positive ER status are discussed.