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Gullet cancer surgery

Table of contents
Gullet cancer surgery
Short history of development of surgery of cancer of gullet
Distribution of cancer of gullet
Surgical anatomy of a gullet
Precancerous diseases of a gullet
Pathological anatomy of cancer of gullet
Clinic and diagnosis of cancer of gullet
Clinical current
Differential diagnosis
Technique of X-ray inspection
Artificial pneumomediastinum
Ezofagoskopiya. Endophoto of a gullet
Cytologic research
Reasons of overdue diagnosis
Indications and contraindications to surgical treatment
Preoperative training of patients
Anesthesia at gullet operations
Surgical cancer therapy of a gullet
Radical operations
The principles and defects in technology of radical operations
Operaiiya of single-step substitution of the resected gullet
Torek's operation — Dobromyslova
Gullet alloplasty
Palliative operations
Postoperative complications

Kazan Valery Ivanovich GULLET CANCER SURGERY, Moscow, 1973

The author at the modern practical and scientific level in detail covers a gullet cancer surgery problem. It describes not only operational equipment, but also a gullet cancer as an oncological problem.
The author the first in the USSR carried out successful transpleural esophagectomies at cancer. At the beginning of 1945 it showed a number of the patients who safely underwent such operations. The original author developed and implemented in practice the doctrine about reflexogenic zones of a chest cavity which anesthesia gave the chance to perform these operations under a local anesthesia novocaine solution.
In the monograph materials about prevalence of cancer of gullet are given in the USSR and other countries, questions of sexual distinctions in cancer cases of a gullet and age features of patients with cancer of a gullet are taken up. In relation to a surgical cancer therapy of a gullet the surgical anatomy of a gullet is stated. At the modern level of oncological knowledge value of precancerous diseases of a gullet and feature of its geographical distribution is lit.
The central part of the monograph is the section devoted to clinic and modern diagnostic methods of cancer of gullet. It is emphasized that the success of surgical treatment is in direct link with early diagnosis of cancer of gullet. In the monograph modern opportunities of detection of cancer of gullet at early stages of its emergence and development are in detail stated. The attention to need to improve teaching oncology in medical schools and institutes of improvement of doctors, to increase oncological literacy of doctors-internistov of policlinics to whom the first the patient handles early symptoms of cancer of gullet is paid.
Indications and contraindications to an operational cancer therapy of a gullet are in detail stated. The author calls at cancer of III In a stage resolutely to refuse expanded radical operations in favor of palliative.
The second part of the monograph is devoted to actually technical issues of operations at a gullet cancer. The main attention is paid to the choice of this or that method of operations. The author insists on the individual solution of this question. It polemizes with supporters of operation of Torek — Dobromyslova as choice operations. The single-step intrathoracic anastomosis after an esophagectomy concerning cancer, according to the author, has to be applied at "safe" patients with the first stages of a disease, but with the essential reservation: at indistinct performance of an anastomosis, at doubt that it is imposed without tension, it is necessary to remove an anastomosis and to finish operation on Torek — to Dobromyslov.
The separate section is devoted to an anesthesia at gullet operations. Palliative operations at considerably inoperable cancer of a gullet and the substituting operations after its resection are in detail lit.
The author considers that at improvement of diagnosis of early stages of cancer of gullet and radical operating of patients direct mortality after operation can be considerably reduced, and the long-term results are improved.
FROM THE AUTHOR
Quarter of the century the author studies a cancer of a gullet and actively operates patients with this disease.
Our USSR's first successful operations of patients with cancer of a gullet (1944) gave hope for fast permission of this the problem, most difficult in surgery. A gullet cancer — cancer visual. A bright symptom is the dysphagy. It seemed, it is necessary to improve only in details technology of operation, to develop a technique of anesthesia and bulk of the patients with cancer of a gullet who are considerably operated in early stages will long live, relieved of this really painful remediless disease.
Outstanding Soviet surgeons joined in research and development of new methods and technology of radical operations on a gullet (E. L. Berezov and Yu. E. Berezov, B. V. Petrovsky, M. S. Grigoriev, A. Vishnevsky, S. V. Gay national, E. N. Wangqiang, B. A. Petrov, A. E. Pechatnikova, V. I. Popov and I. Filin, A. A. Polyantsev, B. S. Rozanov, A. A. Rusanov, A. G. Savinykh, A. I. Savitsky, O. K. Skobelkin, S. Yudin, etc.). Old operational methods were reconsidered and improved, created new modifications, more perfect methods of operative measures at a gullet cancer are developed and implemented in equipment. The technical problem in surgery of cancer of gullet was resolved.

The reorganization of anesthesiology and reanimation and preparation of qualified personnel of anesthesiologists which is carried out to the USSR created premises for careful performance of radical operations at a gullet cancer, improved a postoperative current. Thus, the pathophysiological problem also was resolved with success.

However these achievements in surgery did not give for a cancer therapy of a gullet of impatiently expected favorable results in sense of considerable decrease in a postoperative lethality and longevity of the patients who successfully underwent a radical operation. In what business?
The answer to this question is given by the table given below reflecting results of treatment of patients with cancer of a gullet in our clinic for 1964 — 1968.

 

Year

The general
number
pain
ny

It is operated

Died

in total

for the sake of
kalno

fell
ativno

in total

%

Cancer of chest department of a gullet

1964

24

13

3

10

4

16,6

1965

12

5

2

3

2

16,7

1966

30

18

4

14

7

23,3

1967

14

4

 

4

3

21,4

1968

15

9

2

7

3

23,1

Total  

 

95

49

11

38

19

21,1

The gullet cancer which passed from the cardia

1964

50

30

6

24

8

16,0

1965

29

19

12

7

14

48,2

1966

18

12

2

10

6

33,3

1967

24

16

8

8

5

20,8

1968

25

15

7

8

3

12,0

Total  

 

146

92

35

57

36

24,6

From the table it is visible that for 5 flyings from 241 patients with cancer of a gullet and a cancer of the gullet which passed from an upper part of a stomach, radical operation managed to be made only at 46. The main mass of patients are patients with an advanced carcinoma who have a radical operation even if technically it can be carried out, is senseless. The number of considerably inoperable patients remains same unacceptably big as 25 flyings ago (81%).
With the first complaints of the patient addresses to policlinic, as a rule, to the doctor-internistu. Oncological readiness of polyclinic doctors is obviously insufficient.
The monograph offered the reader is devoted generally to a gullet cancer as a problem oncological — to clinic of cancer of gullet and opportunities of its timely diagnosis.
Techniques of radical and palliative operations are given in the monograph rather briefly, expediency of their use is generally estimated. Exceptions are made only for some rather new offers.
Personal experience and works of our employees on the Central hospital of Ministry of Railways No. 1 (the chief — the honored doctor of RSFSR V. N. Zakharchenko) and department of surgery of the Central institute of improvement of doctors (the department chair — the prof. T. P. Makarenko) formed the basis of this work. These are theses and scientific works R. T. Panchenko, E. O. Kowalewski, V. A. Stefada (Agranenko), A. M. Betaneli, A. N. Kabanov, N. A. Marandov, L. G. Kharitonov, G. Gogolashvilli, R. A. Mumladze, K. V. Ostashkov, N. N. Rasstrigin, Yu. P. Fofanov, K. A. Makarova, M. P. Benenson, L. G. Kraytser, A. V. Bogdanova, the Prince Tsatsanidi, O. A. Narycheva.
X-ray inspections and their treatment were carried out by the staff of x-ray department of hospital (the chief — the doctor of medical sciences V. S. Afanasyeva). Cytologic and histologic researches of smears were carried out by the staff of the central laboratory (the chief of N G. Alekseev and pathoanatomical department of hospital (chief K. A. Makarova). Separate sections of this book are written by my pupils prof. A. N. Kabanov and the prof. N. N. Rasstrigin.
We are very grateful to all specified companions for their work and the help during creation of this monograph.



 
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