Expediency of performing organ-saving operations in multifocal / multicentric breast cancer

The incidence of multifocal (MF) and multicentric (MC) carcinomas varies widely among clinical studies, depending on definitions and methods for pathological sampling. Magnetic resonance imaging is increasingly used because it can help identify additional and conventionally occult tumors with high sensitivity. However, false positive lesions might incorrectly influence treatment decisions. therefore, preoperative biopsies must be performed to avoid unnecessary surgery. Most studies have shown higher lymph node involvement rates in MF/MC tumors than in unifocal tumors. However, the rate of local recurrences is usually low after breast conservative treatment (BCt) of MC/MF tumors. It has been suggested that BCt is a reasonable option for MC/MF tumors in women aged 50-69 years, with small tumors and absence of extensive ductal carcinoma in situ. A metaanalysis showed an apparent decreased overall survival in MC/MF tumors but data are controversial. Surgery should achieve both acceptable cosmetic results and negative margins, which requires thorough preoperative radiological workup and localization of lesions. Boost radiotherapy techniques must be evaluated since double boosts might result in increased toxicity, namely fibrosis. In conclusion, BCt is feasible in selected patients with MC/MF but the choice of surgery must be discussed in a multidisciplinary team comprising at least radiologists, surgeons and radiotherapists.Частота встречаемости мультифокальных (МФ) и мультицентричных (МЦ) карцином широко варьируется среди клинических исследований в зависимости от определений и методов морфологического исследования. Применение магнитно-резонансной томографии широко распространено в связи с возможностью точного распознания дополнительных скрытых опухолей. Однако, ложноположительные поражения могут привести к некорректному выбору лечения. Таким образом, необходимо проведение дооперационных биопсий во избежание неоправданного хирургического вмешательства. Большинство исследований продемонстрировали более высокие показатели поражения лимфатических узлов при МФ/МЦ опухолях по сравнению с унифокальными. однако, частота местного рецидива обычно ниже после проведения органосохраняющего лечения при МФ/МЦ опухолях. Предполагается, что органосохраняющее лечение является целесообразным при МФ/МЦ опухолях в случае с пациентами в возрасте 50-69 лет с небольшими опухолями и отсутствием обширной протоковой карциномы in situ. Согласно метаанализу, наблюдаются низкие показатели общей выживаемости при МФ/МЦ опухолях, однако данный факт остается под вопросом. Хирургическое вмешательство должно обеспечивать как должный косметический результат, так и гистологически чистые края резекции, что требует тщательного рентгенологического исследования и локализации поражений. Необходимо тщательно изучить особенности бустерного облучения, поскольку двойная доза облучения может привести к повышенной токсичности, в частности к развитию фиброза. В заключение, органосохраняющее лечение целесообразно в случае с определенной группой пациентов с МФ/МЦ опухолями, однако решение относительно выбора хирургического вмешательства должно приниматься в рамках междисциплинарного взаимодействия рентгенолога, хирургов и специалистов по лучевой терапии

TO THE QUESTION OF REASONABILITY OF LUNG BIOPSY IN PRIMARY SPONTANEOUS PNEUMOTHORAX

A biopsy of lung tissues was a conventional diagnostic method for detection of disseminated processes in the lung, which weren’t diagnosed on preoperative stage. It was used during surgical anti-relapse treatment of spontaneous pneumothorax (SP). A retrospective analysis of the results of lung parenchyma biopsy was made in 143 patients, who have been operated for SP. Basic entry criteria of the research were: the age younger than 40 years old, a presence of one episode of spontaneous pneumothorax, an absence of complaints for respiratory organs before the development of the first episode of spontaneous pneumothorax. The biopsy with following pathomorphological investigation allowed a formulation of exact variant of disseminated processes, which gave the reason for the development of spontaneous pneumothorax in 9 (6%) patients out of 143. The presence of disseminated processes in the lung was detected with multispiral CT in all these patients on preoperative stage. The study of biopsy material found out the presence of emphysema of different degree of manifestation or fibrosis sites in the rest of the patients. An analysis of presented materials allowed the conclusion, that a performance of biopsy was indicated in the case of suspicion for lung disseminated processes in patients with SP. The biopsy with the following histological study didn’t explain the reason of the development of emphysematous and fibrous changes in lung parenchyma in all other cases. At the same time, it didn’t give the option for pathogenetic treatment and it wasn’t possible to predict the following pathogenesis

INTRAOPERATIVE DETECTION OF SENTINEL LYMPH NODES USING INFRARED IMAGING SYSTEM IN LOCAL NON-SMALL CELL CARCINOMA OF LUNG

The article presents the results of the first domestic experience of intraoperative fluorescence mapping of sentinel lymph nodes in lung cancer. The research included 10 patients, who underwent surgery over the period of time from September 2013 to May 2014. After performing thoracotomy, the solution of indocyanine green (ICG) was injected using subpleural position above the tumor in 3-4 points. Fluorescence (ICG) image guided surgery was carried out by using infrared radiation (wave length 808 nm) on lung surface, root of lung, mediastinum in real time. Fluorescence lymph nodes were mapped. In case that metastatic lesions weren’t revealed in sentinel lymph nodes, they weren’t noted in other nodes. Method specificity consisted of 100%. Biopsy and histological study of sentinel lymph nodes mapped during fluorescence (ICG) image guided surgery could be useful for prevention of lymphodissection in patients with non-small cell carcinoma of lung

SURGICAL TREATMENT OF RESPIRATORY FAILURE IN YOUNG PATIENTS WITH DIFFUSE LUNG EMPHYSEMA

An analysis of results of examination and treatment of 8 young patients (from 25 to 17 years of age) with generalized emphysema of the lungs, pulmonary failure of the II and III degrees was made. The functional examination of the patients before operation has revealed changed respiration by obstructive type. Symptoms of dysplasia of the connective tissue were found in 4 patients. Surgical reduction of the lung volume was performed in 5 patients for correction of respiratory failure. There were neither serious complications nor lethality. Dyspnea by MMRC scale decreased in all the patients at minimum by 1 point during the first months after operation. Three years later 4 out of the operated patients (80%) had retained positive effect of operation. In patients who had no operative treatment the frequency of infectious complications, level of dyspnea during three years of follow-up remained at the same level, while functional indices continued worsening. The surgical method of treatment of severe respiratory failure allowed tolerance of physical exercise to be increased and quality of life of patients with diffuse lung emphysema to be improved

ULTRASONIC ASSESSMENT OF DIAPHRAGM CONDITION OF THE PATIENTS, WHO PASSED THE SELECTION FOR LUNG VOLUME REDUCTION SURGERY

The article showed the results of ultrasonic assessment of topographic and functional diaphragm indices in patients with severe diffuse emphysema. They passed the selection for lung volume reduction surgery. The comparison of diaphragm indices was presented in patients with diffuse emphysema and control group of healthy volunteers. Dynamics of diaphragm condition was studied after surgical treatment. There wasn’t noted any statistical difference of diaphragm topographic indices as compared with the control group. There wasn’t shown a correlation between respiratory function indices and functional diaphragm indices, but it was noted a positive tendency in characteristics during quiet breathing

CRITERIA OF SURGICAL RISK IN PATIENTS WITH DIFFUSE LUNG EMPHYSEMA WITH LARGE AND GIANT BULLAS

The article presents an assessment of postoperative period in patients with diffuse lung emphysema with large and giant bullas on the basis of surgical risk criteria, which were developed for the patients with diffuse emphysema without bullas. Retrospective study determined the group of patients who had high rate of surgical complications after bullectomy. The patients (46) were divided into 2 groups and it depended on the initial condition of the patients. There was stated, that the main criterion of surgical risk was a decrease of the level of OFL lower than 20% of the proper level in patients with large and giant bullas