Cancer of the stomach; a clinical study of 921 operatively and pathologically demonstrated cases . reater omentum has been divided close to the greater curvature and thepylorus has been doubly clamped and sectioned. Portion to be exciseddelimited by dotted lines. experience in any of these cases, it is doubtful whether theadditional danger to the life of the patient caused by cuttinginto the pancreas will be compensated for by the proba-bility of the permanency of a cure. The entire portion of the stomach containing the cancer,together with at least 3 cm. of apparently normal tissue in 448 GAN
Cancer of the stomach; a clinical study of 921 operatively and pathologically demonstrated cases . reater omentum has been divided close to the greater curvature and thepylorus has been doubly clamped and sectioned. Portion to be exciseddelimited by dotted lines. experience in any of these cases, it is doubtful whether theadditional danger to the life of the patient caused by cuttinginto the pancreas will be compensated for by the proba-bility of the permanency of a cure. The entire portion of the stomach containing the cancer,together with at least 3 cm. of apparently normal tissue in 448 GANGER OF THE STOMACH the direction of the duodenum including the pylorus andat least 6 cm. toward the cardiac end of the stomach ofapparently normal tissue is in this manner entirely loosenedfrom all surrounding tissues. Especial attention should be directed toward the import-ance of preventing injury to the arteries supplying thetransverse colon. In order that the latter viscus may notbecome necrotic as a result of interference with its bloodsupply, a strong stomach clamp is next applied to the. X^ajje^naitt Fig. 97.—Excision of pylorus and antrum of stomach with end-to-sidegastrojejunostomy for multiple malignant ulcers just proximal to thepylorus. Dotted line shows projected line of excision. Clamps in posi-tion for section of pjdorus. upper end of the duodenum. A second clamp is appliedto the stomach at a point chosen for resection, then two otherclamps are apphed to keep the contents of the portion tobe removed from soiHng the peritoneal cavity when theportion is cut away. The intervening portion is thenremoved by cutting along the edge of the two clamps whichwere apphed first. The treatment of the two stumps must now be enough of the duodenal end is left to invert the cut endof this structure, this may be accomplished in variousways. A purse-string suture of silk or linen should be SURGICAL TREATMENT OF CANCER OF THE STOMACH 449 applied 1 cm. below the clamp
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