Surgical treatment of patients with bronchopulmonary cancer and major anesthetic-surgical risk: Summary of the doctoral thesis for the habilitation in medical sciences: 321.13. – Surgery

Abstract

Thesis structure: The text of the thesis is set out on 203 computer-processed basic text pages, consisting of: list of abbreviations, introduction, 7 chapters, general conclusions, practical recommendations, bibliography from 310 sources and 3 appendices. Illustrative material includes 48 tables and 53 figures. The results are published in 25 scientific papers. Keywords: Bronchopulmonary cancer, anesthetic-surgical risk, fascial plane echogenic block, prehabilitation, extended operability criteria, accelerated rehabilitation protocols, survival rate. Field of study: Medical sciences, clinical medicine, surgery (321.13). Purpose of the research. To develop a multimodal perioperative approach to patients with bronchopulmonary cancer

and advanced anesthetic-surgical risk, allowing to extend operability criteria for increasing life expectancy and reducing post- operative complications.

Research objectives: (1) Preoperative evaluation of the patient with bronchopulmonary cancer and advanced anes- thetic-surgical risk with individualized prehabilitation program (2) Traditional approach in patients with advanced anesthetic- surgical risk. (3) Usefulness of scores: Charlson, Th-RCRI, ASA and MET in perioperative management and treatment outcomes.

(4) Determinants of perioperative mortality: identification, description and analysis for optimizing risk management. (5) Echo- genic fascial plane blocks: their role in accelerating postoperative recovery. (6) Intraoperative bleeding reduction strategies: their

impact on postoperative recovery. (7) Analysis of postoperative outcomes: development of a rational diagnostic-curative algo- rithm.

Scientific novelty and originality. It investigated for the first time the surgical approach in patients with lung cancer and advanced anesthetic-surgical risk, a category traditionally considered eligible only for chemotherapy or radiotherapy. It demonstrated the feasibility of surgery in well-defined subgroups of patients, with postoperative outcomes and two-year survival prognosis significantly superior to the traditional approach. Specific risk factors were identified and parameterised to select eligible patients from the high anesthetic-surgical risk group. Predictive models of perioperative mortality based on integrated

severity scores were developed and validated. A perioperative management strategy, including prehabilitation, accelerated post- operative rehabilitation, intraoperative antifibrinolysis and anterior serum analgesic block, was successfully implemented, in- creasing the body's resilience to operative stress and promoting return to homeostasis.

The important scientific-application problem solved. A new conceptual approach to eligibility and perioperative management has expanded the operability criteria for patients with lung cancer and advanced anesthetic-surgical risk previously considered inoperable. Mathematical predictive models of postoperative mortality, based on severity scores (Th-RCRI, Charlson, MET, ASA) and planned lung resection volume, allow individualization of the therapeutic option (surgical vs. non-surgical). Patients operated according to extended criteria and managed perioperatively with prehabilitation and accelerated postoperative rehabilitation show a significant increase in life expectancy compared to the traditional approach.

Theoretical significance, applied value and implementation of scientific results. The paper presents a critical syn- thesis of the literature on accelerated postoperative rehabilitation in thoracic cancer surgery, with the aim of identifying previ- ously inoperable patients who may benefit from intervention. Theoretical, methodological and practical bases are provided for

preoperative assessment, prehabilitation programmes, accelerated postoperative rehabilitation and intra- and postoperative care of the patient with bronchopulmonary cancer and increased anesthetic-surgical risk, with the aim of increasing survival rates. The innovative approach expands operability criteria, allowing more patients to benefit from surgical treatment with significantly

better clinical outcomes in terms of survival rate and life expectancy. The results provide practical recommendations for clini- cians in risk assessment, prehabilitation and preoperative preparation, with a focus on reducing postoperative pain and acceler- ating recovery through anterior serratus plane block and tranexamic acid administration.

Implementation of scientific results. The research results were implemented in current clinical practice in the Thoracic

Surgery Department of the Institute of Emergency Medicine, Chisinau, Republic of Moldova. The implementation acts are at- tached in Annex no. 1-2.