Surgical Procedures with Questionable Indications: A Letter from Russia

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Surgical Procedures with Questionable Indications: A Letter from Russia

Journal Title: Journal of Surgery - Year 2016, Vol 4, Issue 1

Abstract

Partial isolation of Russian medicine and medical research from the international community had consequences for the healthcare. Obviously, it is one of the causes of the relatively low life expectancy [1]. According to the author’s estimates after a practice abroad, an average size of malignant tumors in surgical specimens was considerably larger in central Moscow clinics compared to hospitals in some countries of Western Europe, which means that early detection of malignancies is less efficient in Russia. Abroad, almost all mastectomy specimens were without muscle. In Moscow hospitals, the modified radical mastectomy (Patey) with the removal of the pectoralis minor muscle has been the standard procedure in the last decades; but the Halsted operation with the removal of both major and minor pectoralis muscles was applied as well. The Halsted operation prevailed earlier; it was recommended by Soviet-time textbooks for all types of breast cancer. The Halsted operation was presented as a main treatment modality for breast cancer even in some handbooks edited after the year 2000 [2,3]. The worldwide tendency towards conservation in the treatment of breast cancer remained largely unnoticed in the former Soviet Union (SU) for a long time. Today admittedly, mastectomy without muscle removal is becoming increasingly prevalent. Furthermore, the negative appendectomy rate has been relatively high in Russia probably favored by the outdated concepts of catarrhal and chronic appendicitis not requiring histological signs of acute inflammation for the diagnosis [4]. Appendices morphologically indistinguishable from the norm have been habitually reported as compatible with appendicitis, surgeons thus receiving no feedback from pathologists. Thermo-, diathermo- or cryo-coagulation of cervical pseudo-erosions (endocervical ectopy) regardless of the presence of epithelial dysplasia, has been routinely applied in the former SU. Coagulation of an endocervical ectopy without neoplastic or preneoplastic lesions is at variance with scientific evidence not supporting the hypothesis that it protects against cervical cancer [5]. Cervical ectopies were found at mass examinations and treated by electro- or thermocauterization [6,7]. The complications of such approach were noticed later [8-10]. It was recommended to start the treatment of the pseudo-erosions possibly early, while large lesions were to be treated by diathermoconization i.e. conization by means of an electrocautery device [11], a procedure known to be associatedwith complications [12]. It should be noted that according to the international literature, “in most women during the reproductiveperiod, the mucin-secreting columnar epithelium of the endocervix is present on the cervical portio, forming the endocervical ectropion or cervical ectopy” [13], in particular, if hormonal contraceptives are taken in. Cervical conization is a new procedure in Russia; primary hysterectomy has been generally applied. Pap-smears have been rare, cervical cancer being diagnosed at a relatively advanced stage [14/a>]. In this letter are discussed several invasive procedures deviating from the international practice.

Authors and Affiliations

Sergei V. Jargin

EP ID EP203815
DOI 10.13188/2332-4139.1000027
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