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The Surgical and Nonsurgical Treatment of Gastric Ulcer An Analysis with Special Reference to the Incidence of Cancer

AMA Arch Surg. 1959;79(2):326-332. doi:10.1001/archsurg.1959.04320080162019.
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The treatment of gastric ulcer that does not possess characteristic appearance of malignancy by x-ray, gastroscopic examination, or cytological washings has sustained a continuing controversy that at one extreme will have those who state dogmatically, "All gastric ulcers should be resected," and at the other a massive stoic conservatism against surgical excision. Surgeons and gastroenterologists only too often infer that their therapeutic domain has been trespassed upon by the other. Usually both groups are quite capable of substantiating their position by citing instances, on one hand, of faradvanced gastric malignancy attributed to prolonged attempts at conservative treatment and, on the other, to "unnecessary operations" because of failure to demonstrate malignancy in tissues removed by gastric resection.

The pivotal point of this argument rests upon the lack of absolute reliability of any diagnostic procedure except carefully studied microscopic serial sections of the diseased area. Until such time as the diagnosis can


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