According to the World Health Organization, half of all drugs available on the global pharmaceutical market are sometimes used for indications that are not included in the instruction for use. This method of therapy has the term “off-label use” which means the use “out of instruction”. Today, off-label drugs are also prescribed for cancer treatment. For example, a drug developed to treat one type of tumor can sometimes be used to treat other types of cancer. The treatment of certain types of pain with tricyclic antidepressants is also an example of the off-label drugs used in oncology. An example of an off-label prescription is anxiolytic medicine lorazepam, which can be used off-label as an antiemetic in cancer patients. Low doses of naltrexone are applied to treat cancer and autoimmune diseases. A retrospective analysis of modern oncotherapy indicates that oncologists often use off-label drugs in combination therapy, especially in the treatment of patients with concomitant diseases, in case of progressive development of the tumor, or to reduce the toxicity and cost of treatment components. American oncologists are of the opinion that if all the drugs prescribed by the International Recommendations failed in the treatment of cancer, doctors can prescribe off-label medications, but only if their effectiveness and safety are clearly established. The problem of the off-label use of drugs in oncology has not yet been studied in detail, however, this direction has certain promising prospects.
Abstract. Introduction. To date, complete cure from esophageal cancer/MS/and gastroesophageal cancer/GER/can only be achieved surgically. At the same time, the five-year survival rate of patients is from 25 to 35 % according to various authors. At the same time, postoperative mortality in MS and GER reaches 15%, and only in leading clinics it is 3–9 %. In the treatment of cancer of these localizations, there are many controversial issues, namely the issue of optimal surgical access in cancer of various anatomical departments of the esophagus and GER, the volume of lymphodissection, the reconstructive stage of surgery, the relation to splenectomy. There is insufficient information on the prevention and treatment of postoperative complications. Purpose. Establish the nature of postoperative complications in patients with MS and GER and study the possibilities of preventing their development. Materials and methods. The results of surgical treatment of 219 pa-tients with esophageal cancer/MS/and gastroesophageal cancer/ GER/are presented. The patient underwent surgical interventions according to the method of Lewis/98/and Osava-Garlock/121/. The formation of esophageal-gastric anastomosis was carried out manually without the use of cross-linking devices. Preferred plastic submerged esophageal-gastric anastomosis, which has high reliability and good functional properties. Postoperative complications and factors that cause them were analyzed. The clinical case of diagnosis and treatment of gastric graft rotation is presented. Research results. Complications in the postoperative period occurred in 34.95 % of patients. The leading place was occupied by somatic complications: cardiovascular 17.1% and pulmonary 12.0 %. Complications from esophageal ventricular anastomosis occurred in only 4 (1.8%) patients, and in no case this led to the death of the patient. Intrapleural bleeding from the chest wall (1.4 %) and gastric cookies (1.0%) were very rare. There are also complications in the form of gastric graft rotation and complete obstruction. This complication was eliminated by the imposition of gastroenteroanastomosis on the abdominal gland of the stomach in laparotomy. Deaths were caused in 3 (1.4 %) patients with cardiovascular insufficiency and in 1 (0.5 %) patient with TELA. Conclusions. Prominent in the structure of postoperative complications are therapeutic: cardiovascular and pulmonary, they account for more than 80% of all complications. The most common cardiovascular complication is a heart rhythm disorder. The method of formation of esophageal anastomosis is a separate independent side of the problem. The search for the optimal method continues. However, in our opinion, the result depends not so on the method used, but how this method corresponds to the principles of optimal healing of anastomosis and the correctness of its technical performance. For the prevention of transplant rotation during surgery, control of its location, both from the chest and abdominal cavity, is necessary, so the latter is sutured only after the formation of esophageal-gastric anastomosis. In gastric graft rotation, urgent surgery is shown to perform drainage surgery.
Background. Esophageal cancer (MS) ranks 14th in the structure of cancer in the population of Ukraine. Gastroesophageal cancer (GER) is several times more common. It is estimated that cancer in this area accounts for more than 20 % of all stomach cancers. The results of cancer treatment in this location are the worst among other cancers. This is due to high neglect in newly diagnosed patients, high postoperative mortality (15 %) and low five-year survival. Purpose. To analyze the literature sources related to esophageal cancer and gastroesophageal cancer surgery development in chronological terms and to define the main directions for further development of surgery of this pathology. Materials and methods. The literature review has involved available full-text contributions obtained via literature search in domestic and foreign databases. The search was restricted to the studies published within the 1975–2020 timeframe. Special emphasis was placed on the effectiveness analysis of lymph node dissection and methods of esophagogastric anastomosis forming, in a comparative aspect. The paper also analyzes the materials of the authors’ own long-term studies related to this issue. From 1990 to 2018, 250 patients with esophageal cancer and gastroesophageal cancer were treated at SO «IMR of the NAMS of Ukraine» and the regional clinical oncology dispensary. Results and discussion. Literature suggests that the failure of the esophageal-gastric anastomosis is secondary among complications. Cardiovascular and pulmonary complications come first. When performing 3-zone lymph dissection increases five-year survival by 10 %. The inability of the esophagogastric anastomosis in leading clinics is from 3 to 9 %. Performing a plastic esophagogastric anastomosis increases its physiological properties. Conclusions. Thus, surgical treatment remains the main strategic direction in the treatment of MS and GER. The primary goal of treatment is the survival of patients. Data from literature sources indicate the need for mandatory mediastinal and abdominal lymph dissection. The most successful results of treatment of esophageal cancer and gastroesophageal cancer were obtained in leading specialized oncology clinics where the lowest postoperative mortality is observed. Treatment of cancer in this location requires the use of adjuvant treatments (chemotherapy and radiation therapy).
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