The patient who harbors a gastrointestinal carcinoma is doomed unless the growth is removed by a surgical operation. The contraindications for the removal of such a primary growth are decreasing. The primary lesion is being removed with increasing frequency because of a constantly decreasing primary mortality. Two questions must be answered:
1. What is responsible for the decrease in the primary mortality?
2. Should one remove the primary malignant lesion if it is impossible to eradicate all gross evidence of the disease, such as metastases in the liver or in the regional lymph glands?
The lowering of the primary operative mortality of gastrointestinal carcinoma is not due solely to an extensive surgical experience coupled with a perfection of surgical technical procedures. Superb technical skill avails little if the patient's condition is such that he cannot tolerate without disaster the necessary operative procedure. The surgeon must pay tribute and acknowledge his