Preservation of the pyloric antrum in resection of high gastric malignancies.
نویسنده
چکیده
URING an operation one is frequently faced with circumstances in which consideration of operative technic calls for an extension of the resection beyond that required purely on the basis of the pathologic-anatomic findings . Such a situation is exemplified by the rightsided hemicolectomy which is undertaken as a rule even in the treatment of inflammatory conditions when removal of the terminal ileum and ascending colon would satisfy the requisites of radicality . Due to the unreliability of sutures in a segment of intestine free of serosa, such as the partially retroperitoneal ascending colon, it becomes necessary to include in the resection both the ascending and part of the transverse colon. Similar considerations apparently justify the widespread use of total gastrectomy in the treatment of upper gastric malignancies . Although the extent of infiltrative growth would permit the antrum to be retained, it is believed that for the benefit of simplifying the procedure the resection should extend into the upper part of the duodenum, continuity being then established by closing the duodenal stump and performing esophagojejunostomy, or simply by esophagoduodenostomy . This unnecessary sacrifice of the antrum is carried out for two reasons . One of these is based on the views propagated particularly by Lahey that late results in radically treated gastric malignancies could be improved by total gastrectomy . Impetus for this view was supplied by Lahey's data in which one-third of the patients subjected to subtotal resection evidenced a relapse within the gastric stump . Aside from the fact that these particular findings have not been confirmed by other authors, one must realize that in treating a carcinoma of the fundus we are faced by an entirely different problem . The relapses in the proximal gastric stump mentioned previously represent
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عنوان ژورنال:
- American journal of surgery
دوره 94 1 شماره
صفحات -
تاریخ انتشار 1957