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PRINCIPLES GOVERNING TOTAL GASTRECTOMY:  A Report of Forty-One Cases

GEORGE T. PACK, M.D.; GORDON McNEER, M.D.; ROBERT J. BOOHER, M.D.
Arch Surg. 1947;55(4):457-485. doi:10.1001/archsurg.1947.01230080465007.
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IN THE progressive evolution of the scope of subtotal gastrectomy for cancer of the stomach, total gastrectomy has become a necessity in the armamentarium of the abdominal surgeon. From the operation of pylorectomy by Billroth in 1881 to total gastrectomy the entire history of modern surgical technic has developed, and yet the philosophy and approach to the more extensive procedures seem little changed in Lahey's1 anaylsis of the problem in 1938: "... the operation is to be considered only in those cases in which a large part of the stomach is involved; extragastric metastases, even though they are not visible, and the operation is not justifiable if they are visible, are present in practically all of the cases.... In those cases in which the malignant lesion in the stomach is carcinoma, one cannot reasonably expect to be able to accomplish anything more than a prolongation of life but that with

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