. American practice of surgery ; a complete system of the science and art of surgery . The operation seems, in many of these cases, to stimulate thegrowth to a marked degree. For this reason it seems wdse not to attempt theremoval of a carcinoma of the stomach in any case in which it is plain that acomplete removal is impossible. Some years ago, there was laid down, by a number of surgeons, a rule accord-ing to which gastrectomy or partial gastrectomy was permitted only in cases inwhich there was no secondary involvement of lymph nodes, because it seemedcertain that in all of these cases the d
. American practice of surgery ; a complete system of the science and art of surgery . The operation seems, in many of these cases, to stimulate thegrowth to a marked degree. For this reason it seems wdse not to attempt theremoval of a carcinoma of the stomach in any case in which it is plain that acomplete removal is impossible. Some years ago, there was laid down, by a number of surgeons, a rule accord-ing to which gastrectomy or partial gastrectomy was permitted only in cases inwhich there was no secondary involvement of lymph nodes, because it seemedcertain that in all of these cases the disease must have advanced to a hopeless SURGICAL DISEASES OF STOMACH AND (ESOPHAGUS. 397 dciiivc at tlu tiino of (he oiuTatioii. Furtlicr cxiHTiciicc lias shown, however,that this was too broad a sui^position. It lias been iouiub for example, that inmany eases the enlarged lymph nodes are inflammatory in character and do notcontain secondary carcinoma. In any given case, then, in whintire ])rimary growth, it is best to undertake this even. ■ , ^, ■ ^f Pvlorns The diagram shows the arrangement of the Fig. with Carcinoma of t^^ P>1otu-- .Y^i;\^dicates, by means of dotted Unes, carcinoma of the pylorus. though there be an involvement of lymph nodes. Of course, the latter must beverr carefully removed at the same time. It may be well to enumerate the dangei^ which this thorough excisioninvolves, so that they may be kept in mind during each step of the operation :- (1) There is danger of necrosis of the remaining portion of the stomach itcare i not taken to a sufficient supply of blood from the lesser cnn^ature 398 AMERICAN PRACTICE OF SURGERY. of the stomach. Ordinarily this danger can be avoided by not carrying theincision beyond a point a Httle to the right of the coronary artery, but, in caseof an anomalous distribution, which is not altogether uncommon, care nuist betaken to preserve a suitable arterial branch. (2) Injury to the pancreas is li
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectsurgery, bookyear1906
