A more thorough operation for gastric cancer.Anatomical basis and description of technique

Abstract

factors have contributed toward frequent failure in the surgery of gastric cancer. Whereas the stomach has definite anatomical boundaries, its outer surfaces and areas of lymphatic drainage are so closely related to other organs and vascular structures (pancreas, spleen, duodenum, colon, liver, celiac axis, abdominal aorta, superior mesenteric vessels, mid-colic vessels, portal vein, etc.) with which they merge so imperceptibly that the performance of a satisfactory en bloc dissection and resection is seldom attained by the methods that are widely accepted and practiced today. T h e classical concept of Halstead's radical mastectomy, the Miles abdominoperineal resection of the rectum, radical hysterectomy with lymph-node dissection for cancers of the uterus, and resections of the right and left colon offer abundant evidence that a satisfactory surgical technique may be established to effect the cure of an increasing numbers of cancers. In recent years, cancers of the oral cavity, pharynx, and larynx have been attacked by operations of ever-increasing magnitude, resulting in a proportion of apparent arrests of cancers previously unhoped for. Although the stomach is the organ most commonly affected by cancer, surgical techniques for its removal have remained comparatively unstandardized.