[Methodological aspects of expanded operations in patients with lung cancer]

In attempt to improve the results of treatment of locally advanced lung cancer different techniques are presented and described. In 1995-2008 in Thoracal Department of Georgian National Oncological Center lung resection was performed to 2460 patients, to 1368 (55,6%) of which expanded operations were performed. There were 1070 (78,2%) male and 298(21,8%) female. Expanded operations on the right side as well as on the left side were performed in cases when metastatic lesion of mediastinal lymphatic nodes was observed. Sometimes intrasurgical biopsy of lymphatic nodes with urgent histological examination was used to verify metastases of lymphatic nodes of mediastinum. One stage removal of lymphatic nodes with lung or parts of lungs was performed. Mobilization of cellular tissues and lymphatic nodes mediastinum is described. It was accompanied by careful electrocoagulation which provides at some degree the ablasticity of interference. Expanded pneumactomies on the right and on the left sides technically had several distinctions which were defined by the anatomical peculiarities of the right and left hemithorax. For the purpose of one stage removal of paratracheal and tracheobronchial lymphatic nodes, the azygos vien was ligated in all cases of the right side expanded pneumactomy. To get the better approach to tracheobronchial lymphatic nodes in left side expanded pneumactomies, arterial duct and bronchial arteries were ligated in several cases. The removal of paraaortal lymphatic nodes on posterolateral wall of aorta in several cases, due to their site, forced us to legate some intercostals arteries in all cases, when it was possible. We tried to preserve the integrity of large nerve trunks.