RESULTS OF TREATMENT OF NON-SMALL CELL LUNG CANCER IN THE FAST TRACK PROGRAM
Introduction. Lung cancer is one of the common malignant tumors with serious medical, social and economic consequences. One of the methods of treatment is surgical, but at the same time, pulmonary operations belong to the group of high trauma and often leads to complications associated with pre, intra, and postoperative management. The development and implementation of Fast Track programs can reduce the number of complications, the duration of the recovery (postoperative) period and achieve the earliest possible recovery of the patient. Aim of the study. To evaluate the results of non-small cell lung cancer treatment after the implementation of Fast Track Program (FT) in the early postoperative period. Materials and methods. We carried out a clinical non-randomized non-controlled study of 30 patients with functionally operable non-small cell lung cancer who received operative treatment and follow the FT in the conditions of the Semey Center for Nuclear Medicine and Oncology from September 2018 to the end of March 2019. Results were analyzed using descriptive statistics methods. Data is presented as absolute numbers and percentages. For processing of the statistical significance of differences in groups, Mann-Whitney, Fisher and Student criteria were used. The critical level of significance of differences in groups was set at p <0.05. The statistical analysis procedure was performed using the SPSS 20 program. Results. The study group consisted of 10 (33.33%) women and 20 (66.67%) men, the average age was 63.45 years. Operational access to 93.33% (28 patients) was carried out using the Video-assisted Thoracoscopic Surgery (VATS) method. The spirography index – FEV1, taken to control the dynamics of changes in lung function, increased significantly compared with the baseline (p <0.01), from 51.50% from normal to 78.2% after one month of breathing exercises. The median number of bed-days spent in the hospital after surgery was 4.5 days (maximum 21 and minimum 1). Patients were activated according to FT program for 6-8 hours after surgery (maximum for 2 days, minimum for 1). Immediate postoperative extubation was performed in 15 patients (50.0%). The earliest postoperative transfer to a ward was possible in 20 patients (66.67%). The drainage of the pleural cavity was performed on the principle of “single drainage”. Removal of the tube was performed with the amount of liquid less than 200.0 ml, the median was 2 (maximum on day 4, minimum 2). The timing of the removal of the urinary catheter mainly fell on the first day (mostly 6 hours after awakening) (maximum for 1 day, minimum for 1). The absence of complications was in 22 cases (73.33%). Conclusion. The analysis of the results of the developed and implemented FT method of treatment of non-small cell lung cancer showed the effectiveness of preoperative preparation at the outpatient stage (correction of hemoglobin, erythrocytes, platelets, coagulation rate and bleeding duration; cessation of smoking; treatment of associated diseases, consultation of the anesthesiologist) intraoperative period – use of VATS and regional anesthesia (intercostal neuromuscular blockade); in the postoperative period - immediate ubation, early activation (for 1 day), early transfer to ward mode (after 1 day), early oral nutrition (1 day), the principle of “one drainage” with early removal, removal of the urinary catheter 6 hours after extubation as shorter hospital stay (average number of bed-days is 6.5) and the number of postoperative complications (the total number of postoperative complications is 10%, including atelectasis - 3.33%, suppuration of the postoperative wound - 3.33% and pneumothorax 3.33%).
Shyngys Adilgazyuly, Tasbolat A. Adylkhanov 1, Alfiya R. Nazarova 1, Edil R. Nasibullin 2, Eldos E. Smailov 1, Olga B. Andreeva 1 1 Department of Clinical and Radiation Oncology, NСJSC "Semey Medical University"; 2 Surgical Department, Semey Center of Nuclear Medicine and Oncology, Semey, Republic of Kazakhstan
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Adіlgazyuly Sh., Adylkhanov T.A., Nazarova A.R., Nasibullin E.R., Smailov E.E., Andreeva O.B. Results of treatment of non-small cell lung cancer in the Fast Track Program // Nauka i Zdravookhranenie [Science & Healthcare]. 2019, (Vol.21) 3, pp. 116-127.