Resection of the Stomach and Colon for Certain Forms of Gastric Carcinoma

1914 American Journal of the Medical Sciences  
Perthes (Zcntralbl. f. Chir., 1913, xl, 1097 says that surgeons are divided on the question of what to do in cases of gastric carcinoma with adhesions to the meso-colon, the excision threatening gangrene of the transverse colon. Some surgeons regard these cases as inoperable, while others do not. Some will first resect the car¬ cinomatous portion of the stomach and then decide whether or not the colon should be resected for threatened gangrene. Perthes advises in all eases in which the branches
more » ... which the branches of the colica media are involved in the carcinomatous process that the operation from the beginning should contemplate a simultaneous resection of the transverse colon, great omentum, meso-colon and stomach. When the abdomen is opened and a gastric car. inoina is found, which is removable, hut adherent to the meso-colon, an opening is made in the ineso-colon and the relations of the .ancer to the pancreas determined. Firm adhesions to the pancreas will decide that the cancer is inoperable. If sucli adhesions are not present and the branches of the colica media are involved in the carcinoma, the meso-colon is ligated and divided centrally from the growth, and the transverse colon is clamped on both sides of tlie division of the meso-colon, and divided between the clamps. The two divided end are immediately closed. Then the gastro-hepatic omentum is ligated and divided along the lesser curva¬ ture, and the duodenum divided between clamps and closed as in the Billroth II resection of the stomach. The meso-colon, transverse colon and stomach arc then divided on the oral side, in a similar manner and the whole diseased tissue removed in one piece. This gives a good exposure of the region behind the stomach, for finding and remov¬ ing involved lymph glands. The whole transverse opening of the gastric stump is anastomosed to the uppermost loop of the jejunum. The closed stumps of the colon arc then anastomosed, side to side. Sometimes it will be necessary to mobilize the hepatic and splenic flexures of the colon in order to bring the two stumps together properly. Perthes has done this operation in 4 eases. One patient died 5 days after operation from pneumonia. The 3 other patients were discharged healed. This mortality is just the same as for resection of the stomach for carcinoma, in general, in the Tubingen clinic, in the last two and a
doi:10.1097/00000441-191402000-00026 fatcat:umgvpokhzjavfdah7e3hmkno4i