Although so far back as 1810 Merrem, operating on a clog, showed the possibility of a successful removal of the pylorus, the operation was not performed on man until April 9th, 1879, by Pean, the first successful operation being by Billroth, on Febuary 28th, 1881.
It is now universally recognised that a radical operation for the complete and wide removal of the growth should be the aim of surgical treatment for cancer or sarcoma of the stomach.
For gastrectomy to be entirely successful it is desirable that the operation should be undertaken at an early stage of the disease, before extensive adhesions have formed, before the lymphatics have been seriously invaded, and before secondary growths have developed.
The idea that it is too late to perform a radical operation when a perceptible tumour is present is exploded, as it is well known that many partial and even complete gastrectomies have led to successful issues in the presence of large tumours ; for instance, in one of my cases the tumour on removal weighed a pound, and the operation was only just short of total gastrectomy, yet the patient is in good health over six years later.
It should not be lost sight of that the presence of enlarged lymph-glands does not necessarily imply their cancerous invasion, as ulcers alone or the inflammation of a cancerous tumour may cause glandular enlargement without there being cancerous infiltration of the glands; this I have found on several occasions.
Firm adhesions to neighbouring organs, liver, pancreas, gall-bladder or colon, or to the parietes, as a rule, forbid a radical procedure, though in one of my cases the removal of the gall-bladder, a portion of the liver and the pylorus, as well as a considerable area of parietal peritoneum and the overlying rectus muscle, was not only followed by recoveiy, but the patient is well over six years later, the disease having been proved to be cancer, not only by the clinical record, but by its feel and appearance and by microscopic investigation.
If the tumour, though somewhat tied up by adhesions, is movable, even if adherent to the colon, it need not necessarily be given up as hopeless, as under such circumstances a number of successful partial gastrectomies, including partial colectomy, have been performed. I have also successfully removed a part of the pancreas which was adherent to, and apparently infiltrated by, a growth of the pylorus.
No good purpose will be served by a gastrectomy that does not remove the whole of the disease, as recurrence will be certain to occur, and probably as much relief with a very much diminished risk would be given by a smaller operation.