The practice of surgery . ical operations and palhative operations, andthe choice depends upon the site and extent of the disease. We excisecancer of the stomach when the growth is small, the lymphatic connec- CANCER 149 tions but slightly involved, and when no metastasis exists. We performpalliative operations to relieve impending starvation, and for pain andvomiting. The radical operations are pylorectomy, partial gastrectomy,and total gastrectomy; and the difficulties of these operations are inthe same order. Practically, however, a mere pylorectomy is of littleservice in cancer, because it
The practice of surgery . ical operations and palhative operations, andthe choice depends upon the site and extent of the disease. We excisecancer of the stomach when the growth is small, the lymphatic connec- CANCER 149 tions but slightly involved, and when no metastasis exists. We performpalliative operations to relieve impending starvation, and for pain andvomiting. The radical operations are pylorectomy, partial gastrectomy,and total gastrectomy; and the difficulties of these operations are inthe same order. Practically, however, a mere pylorectomy is of littleservice in cancer, because it is not radical enough. Partial gastrectomyis the more common and satisfactory operation. The mortality variesbetween 8 and 50 per cent., but as we are getting these cancer casesearlier, we are securing a lower operative mortality and an increasingnumber of permanent cures. The accompanying cuts (Figs. 74-77)illustrate the operation which I have been using. It is the operationdescribed and advocated by W. J, Mayo in Fig. 75.—Showing methods of excision. Note that all the glands in the greatercurvature are removed in every case (after W. J. Mayo, Ann. Surg.). Open the abdomen through the right rectus muscle, and turn outthe stomach and omentum. Tie off the gastrohepatic omentum closeto the liver, thus opening widely the lesser omental cavity and mobiliz-ing the pylorus. Pack off with gauze the entire area exposed. Then tiethe four important arteries, two above the stomach and two below gastric artery is best secured at once by double ligature where itjoins the lesser curvature, about an inch below the cardia. The superiorpyloric artery, a branch of the hepatic, is tied just above the get at the tv/o lower vessels, pass the left hand into the lesser cavitybehind the pylorus, find the gastrocolic omentum, and raise it fromthe transverse mesocolon; then isolate and secure from the front the loU THK right gastro-epiploie artery. Next tie the loft
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1910
