SYNOPSIS This paper presents practical points concerning palliative surgery for carcinoma of the stomach. The results which may be obtained are evaluated.Surgery for carcinoma of the stomach as we know it in Great Britain carries a high operative mortality and a low proportion of lasting cures. Most of the operations are therefore doomed to be no better than palliative. However, the likelihood that symptoms will be alleviated is very good, and palliation may reasonably be hoped to last for a year or two even though the patients are mostly elderly.A palliative operation lengthens the lives of some and shortens those of others, but it relieves the vomiting in most and is without question potentially the most humane treatment. To deserve this description, however, it must avoid the implication that those who succumb shall have to suffer pointlessly in the interval between operation and death, intubated, splinted, dripped, and miserably uncomfortable. It is the doctor who has watched the sometimes disastrous sequelae of ill-planned, illmanaged, would-be surgical palliation who is apt to say, 'I would rather my patients died of their diseases than of their treatments'. The management described here avoids this threat.A distant metastasis which is easily removable does not contraindicate palliative surgery. Indeed, the pathology is not always what it has been taken to be. A huge gastric ulcer in a patient of 77 was thought to be neoplastic, partly because there was a hard nodule at the umbilicus, but this turned out to be a sebaceous cyst. Another old lady who had a palliative total gastrectomy for a leather bottle stomach also had a mass of carcinomatous glands resected from the left axilla. These were found to contain spheroidal-celled growth, and a microscopic second primary was found in the breast at
The operation of vagotomy was suggested as long ago a's I812 by Brodie and was tried in cases of gastric crises by Exner and Schwatzman in 1912, and Latarjet in 1923. Bircher (1920, Steirlin (1920)
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