The Place of Extended Gastric Resection in the Treatment of Gastric Malignancy

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EXTENDED gastric resection is required in some patients if the primary malignant growth is to be removed completely in the hope of cure. An extended resection does not necessarily imply total gastric resection. It does imply removal of adjacent organs or structures involved by extension of the primary cancer. Enough stomach should be resected to insure the removal of an adequate margin of normal tissue around the tumor; and neighboring structures such as the mesentery of the transverse colon, the transverse colon itself, part of the pancreas with the spleen, or portions of the diaphragm or left lobe of the liver, may be removed en bloc with the stomach. If the patients are properly selected, the results often are gratifying; but if extended operations are used routinely in the treatment of hopelessly advanced malignant disease, cancer is isseminated and nothing but harm is done.

The following cases are illustrative of satisfactory results.

Case 1. (S.O.H.) Survival for 4 years and 363 days after partial proximal esophagogastrectomy with resection of the spleen and portions of the left lobe of the liver, pancreas, and diaphragm. The patient, a 40-year-old man, had a large tumor involving the entire upper end of the stomach with extension into the diaphragm, the left lobe of the liver, and the hilum of the spleen. The extended resection was undertaken in the absence of distant metastases and because of the comparative youth and good general condition of the patient. Additional diaphragm was removed when frozen section study showed. . .



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