Changes in Surgery for Carcinoma of the Stomach

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CARCINOMA of the stomach continues to be a most perplexing problem both from diagnostic and therapeutic standpoints. Too often the cancer has been present so long and has spread so insidiously that removal is impossible. Wangensteen1 estimates that the usual neoplasm has been present for 20 months before it causes any symptoms, and that six months elapse before the symptoms are sufficiently severe for the patient to see a doctor. It is not surprising that the most favorable reports show a resectability rate of only 50 to 60 per cent of these long existing lesions and that the five year survival rate is so low.

Several new developments in the surgical attack on gastric cancer have occurred during the past 10 to 15 years and may influence the outlook for the patient with carcinoma of the stomach. These changes have been: (1) Tissue diagnosis has replaced “clinical judgment” regarding operability; (2) It has been realized that operability cannot be determined by roentgen examination of the stomach; (3) Extension into the esophagus is no longer regarded as a contraindication to operation; (4) Extension into neighboring organs is not a contraindication to operation; (5) As has been indicated by Guiss,2 “There is an increasing tendency to determine true resectability by laparotomy;” (6) Total gastrectomies have been advocated for carcinoma of Borrmann's type IV by some1 and for all carcinomas of the stomach by others.3,4,5,6,7 More recently Lahey8 stated that he did not believe that total gastrectomy was indicated for the low prepyloric . . .



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