Recent Developments Resulting in an Increasing Operability Rate for Cancer of the Stomach

Abstract

Although little has been contributed to the technical aspects of gastric surgery since the days of Billroth, Hoffmeister, and Polya, developments in the past two years have enabled us to double the operability rate of cancer of the stomach and to reduce simultaneously the mortality rate to nearly half of its previous figure. Since 1938 the number of gastric resections for cancer of the stomach at the Cleveland Clinic has risen from 15 per cent to 30 per cent of all cases seen. At the same time the mortality rate for these operations has fallen from 25 per cent prior to 1939 to 15 per cent in the thirty-three cases having resections in the past two years. If cases requiring total gastrectomy or modifications of this procedure entailing esophago-gastrostomy or esophago-enterostomy are excluded, the mortality rate in partial gastrectomy for cancer of the stomach has been reduced to 7 per cent.

These results have not been obtained as a consequence of technical advances in gastric surgery, nor are they the result of earlier diagnosis. The widening of operability and the lowering of the mortality rate are, I believe, largely the result of the use of sulfapyridine, and of improvements in the technic of anesthesia.

Prior to 1939, the vast majority of gastric resections for cancer were performed under ether anesthesia, and the incidence of postoperative pneumonia was high. Fifty per cent of the postoperative deaths in this period resulted from pulmonary complications. With the use of sulfapy-ridine, pneumonia can be. . .