Removal of a cancerous tumor

Surgical removal of a cancerous tumor remains the most common. It is used almost for all cancers as an independent method, and in combination with radiation, drug therapy. In this case, the removal of a cancer tumor in cancer patients should be carried out according to special rules, non-observance of which leads to unsatisfactory long-term results of treatment, i.e. Reduction of life expectancy of patients.

The basic rules for performing operations in oncology are compliance with ablastics and antiblastics, which are aimed at preventing the scattering, implantation of cancer cells in the wound, which are the cause of relapses and metastases.

By ablastics is understood the removal of the tumor within the limits of healthy tissues in accordance with the principles of anatomical zonality and futility. Removal of a cancerous tumor should be done by a single unit within the anatomical zone, in a holistic case formed by fascial, peritoneal, pleural sheets and fatty tissue. Anatomical zone - JTO is a biologically integral tissue site, formed by an organ or a part of it and related to it by regional lymph nodes and other anatomical structures lying on the path of spread of the tumor process. The outer boundaries of the anatomical zone are determined by such landmarks as the junction of fascial leaves, peritoneal sheets, wide layers of fatty tissue. These interlayers also form, as it were, the wall of the case, beyond which the tissue should be isolated. Blood vessels entering or leaving the case of the case intersect beyond its limits.

Antiblastics provides for the destruction in the wound of the remaining tumor cells. Antiblastics include intraoperative radiation exposure to the bed of malignant neoplasm, treatment of the operating field with chemical substances, intravenous infusion of chemotherapy drugs during surgery, ligation of the main organ vessels prior to mobilization, use of a laser scalpel, etc.

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How is the cancer removed?

Removal of a cancerous tumor is that it determines the ideology of surgical treatment of malignant tumors and forms the philosophy of an oncologist surgeon. The modern principles of onco surgery are formulated by the country's leading oncologist and oncologist, director of the Russian Cancer Research Center (RONC) of the Russian Academy of Medical Sciences (RAMS). NN Blokhin, President of the Russian Academy of Medical Sciences MI Davydov (2002): "Modern oncosurgery, whose strategic goal is to increase the duration and quality of life of patients, should be based on the oncological adequacy of the operation, its safety and the maximum possible functionality." The balance of these principles determines the meaning of the surgical method in oncology, and the main tasks, the solution of which will achieve the main goal, can be formulated as follows.

• Rational surgical access, providing visually verifiable actions of the surgeon and convenient "angle of attack" at all stages of the intervention, and even more so in the event of serious intraoperative complications.
• The minimal risk of local recurrence in the planning of radical surgery achieved by adequate resection of the affected and adjacent organs in the case of an intimate connection with the tumor, whether caused by inflammation or invasion, mobilization of the complex by the "acute route" within the fascial cases - from boundaries of the excised block to the affected organ ("en block" - resection), separate treatment of vessels, thought-out sequence and mobilization techniques with minimal mechanical Exposure to the tumor prior to vascular and lymphatic isolation ( "NO touch» - equipment operating), as well as adequate from the point of view of both volume and surgical techniques of preventive lymphadenectomy, based on the laws of lymphatic metastasis.
• Preventive lymphodissection, the meaning of which can be defined as planned prior to the beginning of surgical treatment, excision of regional lymphocytes, is an indispensable condition for an operation claiming to be radical.
• Elimination and prevention of life-threatening complications of neoplasm, as well as the maximum possible removal of a cancerous tumor as a condition for more effective conservative treatment and providing a better quality of life for patients in the planning of palliative operations.
• Expansion of indications for performing operations in primary-multiple malignant tumors, tumors with invasion of vital organs and major vessels, in elderly patients, patients with severe cardiovascular pathology.
• Optimum in its physiological parameters, the method of reconstruction using simple, reliable and functionally advantageous anastomoses, which guarantees social rehabilitation of operated patients.

Removal of a cancerous tumor is absolutely indicated in the presence of neoplasm within the body or with metastases in regional lymph nodes, complications of the tumor process, threatening the life of the patient (bleeding, obstruction, asphyxia, etc.).

Relative indications for surgical intervention are put in cases where the therapeutic effect can be achieved with the help of radiotherapy or drug therapy.

Removal of a cancerous tumor is contraindicated in oncological and somatic cases. Oncologic contraindications are the distant metastasis or germination of a tumor into unrecognizable anatomical formations. Somatic contraindications to surgery occur in patients with decompensation of the function of vital organs (expressed concomitant pathology, advanced age, etc.).

Oncology distinguishes the following concepts: operability, inoperability, resectability. Operability is a condition of the patient, allowing to carry out removal of a cancer tumor. Inoperability is a condition in which removal of a cancerous tumor is impossible because of the threat to the life of the patient. Rezektvostnost assumes the possibility of removing the tumor. This issue is resolved during an audit during an operative intervention. The result often depends on the qualification of the operating surgeon. In this case, the cause of inoperability (distant metastases, germination in neighboring organs and tissues) should be proved morphologically.

Operative interventions in oncology are divided into diagnostic and therapeutic. Diagnostic operations are performed when the complete characterization of the tumor process, including the morphological one, is not possible before the operation. Sometimes this is possible only during partial mobilization of the organ (for example, with gastric cancer that grows into the retroperitoneal cellulose).

Cancer removal: species

Treatment operations are divided into radical, conditionally radical and palliative removal of a cancerous tumor. The concept of "operation radicalism" is considered from biological and clinical positions. From the biological positions, one can assess the degree of radicalization of an operation only by the length of life. Clinical representation of radicalism is formed on the basis of immediate results of the intervention if the surgeon manages to remove the cancer within the healthy tissues together with the regional lymph nodes. This is possible with neoplasms of the I-II stages. Clinically, conditional-radical operations are those in which, despite the widespread process, it is possible to carry out the removal of a cancerous tumor with regional lymph nodes. In such a situation, the surgeon can not be sure that all tumor cells are removed. As a rule, this is the case with common stage III tumors.

Radical and conditional-radical operations by volume are divided into typical, combined, extended. Typical are such operations, in which, together with resection or extirpation of the organ in which the tumor is localized, regional lymph nodes are removed. Combination refers to an operation in which, along with resection or extirpation of the affected organ, adjacent organs are removed or resected, into which the tumor germinates. Expanded is an operation in which, in addition to the affected organ and regional lymph nodes, remove all available lymph nodes with fiber in the operation area. Extended operations are often performed to increase radicalism in common tumor processes.

In addition to these radical operations, oncology is often used and palliative removal of a cancerous tumor. They are of two types: eliminating complications caused by a tumor, and palliative resections. After such operations, the tumor tissue remains.

Recently, two trends in the development of cancer surgery are clearly visible: the expansion and reduction of the volume of surgical interventions.

The high incidence of combined and advanced operations accounts for a significant proportion of locally advanced neoplasms. This is facilitated by the experience gained over many years, the detailed development of methods of surgical interventions, the introduction of new technologies and achievements in anesthesiology and intensive care. Thanks to the broadening of the surgical intervention limits, more patients with advanced tumors manage to improve long-term results of treatment. A necessary component of this approach is the active involvement of reconstructive and plastic surgery methods for the restoration of deleted tissues.

The second tendency of modern oncological surgery is a reduction in the volume of operations or the abandonment of them in order to preserve the affected organ and damage the tumor in it with the help of radiation or chemotherapy.

Departure from aggressive surgical tactics for organ-preserving treatment can be explained by the following reasons: revision of clinical and biological concepts of the tumor process; perfection of methods of specifying instrumental diagnostics; an increase in the number of patients with initial (I-II) stages of cancer; creation of an effective combination of operative intervention with radiation and medicinal action; creating optimal conditions for rehabilitation and improving the quality of life of patients.

When performing organ-saving operations, modern physical factors are widely used: lasers of high radiation intensity, ultrasonic oscillations of low frequency, plasma flows of inert gases and various combinations of these. This allows to increase the ablasticity of surgical intervention, to increase the life expectancy of patients and to improve cosmetic and functional results.

More and more in recent decades, laparoscopic removal of a cancerous tumor has been introduced into everyday oncological practice. Laparoscopic operations are used in the treatment of tumors of the urinary tract, genitals, colon and other localizations. Advantages of laparoscopic access are low traumatism, reduction in the period of rehabilitation of patients, reduction of hospital stay and good cosmetic effect. According to the surgeons, who perfectly master the technique of laparoscopic operations, long-term results of treatment with correctly delivered indications do not suffer to it.

[3], [4], [5], [6]