CA: A Cancer Journal for Clinicians, Vol 3, 180-183, Copyright
© 1953 by American Cancer Society
Changes in Surgery for Carcinoma of the Stomach 1940 through 1952
Charles H. Brown M.D.1
1 The Department of Gastroenterology, Cleveland Clinic, and the Frank E. Bunts Educational Institute Cleveland, Ohio.
The surgical approach to gastric carcinoma in the years 1940 to 1945 has been reviewed and compared with the present surgical attack (1950 through 1952). This comparison leads to several conclusions:
1. Little is left to "clinical judgment" short of exploration.
2. Neither physical examination (a fixed mass) nor roentgen-ray examination of the stomach determines operability. Esophageal involvement is no longer a contraindication to surgery. The only contraindication to surgery is [SEE TABLE 1 IN SOURCE PDF.] the presence of distant metastases, proved by tissue diagnosis.
3. A tissue diagnosis is necessary in each case. A suspected metastasis may not be metastatic tumor at all or may be a lymphoblastoma sensitive to roentgen-ray therapy.
4. Extension of the disease to neighboring organs and lymph-node involvement are not contraindications to resection. More total and complicated resections are being done now.
5. The operability rate has increased to 90 per cent of all patients and the resectability rate to 55 per cent in 1952. Only one fourth of the patients with gastric carcinoma were given a chance for a five-year survival in 1940 to 1945; now more than half of the patients are given that chance. Without resection, outcome is inevitably fatal.
6. With the increase in operability and resectability and the more extensive procedures now employed, it seems likely that the five-year—survival rate will correspondingly rise from 7 per cent in 1940 to 1945 to 15 to 20 per cent at the present time.
7. Every patient with gastric carcinoma should be regarded as a potential five-year survivor until proved not.
