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

The Surgical and Nonsurgical Treatment of Gastric Ulcer: An Analysis with Special Reference to... Abstract 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 References 1. Allen, A. W.: Gastric Ulcer and Cancer , Surgery 17:750, 1945. 2. Barlow, S. P., and Collins, M. D.: Relationship of Peptic Ulceration to Superficial Spreading Carcinoma of the Stomach , Gastroenterology 32:1152, 1957. 3. Dockerty, M. D.: Certain Pathologic Features of Carcinoma of the Stomach , JournalLancet 75:429, 1955. 4. Dworken, H. J.; Roth, H. P.; Herbert, C. D., and Berger, D. C.: Observations on the Course of Benign Gastric Ulcer and Factors Affecting Its Prognosis , Gastroenterology 33:880, 1957. 5. Flood, C. A., and Hennig, G. C.: Recurrence in Gastric Ulcer Under Medical Management , Gastroenterology 16:57, 1950. 6. Hayes, M. A.: The Gastric Ulcer Problem , Gastroenterology 24:609, 1955. 7. Jordan, S.: Gastric Ulcer and Cancer , Gastroenterology 34:254, 1958. 8. Macdonald, I., and Kotin, P.: Biologic Predeterminism in Gastric Carcinoma as a Limiting Factor of Curability , Surg. Gynec. & Obst. 98:148, 1954. 9. Ransom, H. K.: Subtotal Gastrectomy for Gastric Ulcer: A Study of End Results , Ann. Surg. 126:633, 1947. 10. Smith, F. H.; Bowles, R. S., Jr., and Jordan, S.:: Review of the Problem of Gastric Ulcer , J.A. M. A. 153:1505, 1953. 11. Stout, A. P.: Tumors of the Stomach , in Atlas of Tumor Pathology. Sect. 6, FASC 21, U. S. Armed Forces Institute of Pathology, National Research Council, 1953. 12. Stout, A. P.: Superficial Spreading Type Carcinoma of the Stomach , Arch. Surg. 44:651, 1942. 13. Stout, A. P.: Superficial Spreading Type Carcinoma of the Stomach , J. Nat. Cancer Inst. 5:363, 1945. 14. Zollinger, R. M.; Watman, R. N., and Denkewalter, F.: Should All Gastric Ulcers Be Treated Surgically? Gastroenterology 35:521, 1958. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives Surgery American Medical Association

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

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References (17)

Publisher
American Medical Association
Copyright
Copyright © 1959 American Medical Association. All Rights Reserved.
ISSN
0096-6908
DOI
10.1001/archsurg.1959.04320080162019
Publisher site
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Abstract

Abstract 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 References 1. Allen, A. W.: Gastric Ulcer and Cancer , Surgery 17:750, 1945. 2. Barlow, S. P., and Collins, M. D.: Relationship of Peptic Ulceration to Superficial Spreading Carcinoma of the Stomach , Gastroenterology 32:1152, 1957. 3. Dockerty, M. D.: Certain Pathologic Features of Carcinoma of the Stomach , JournalLancet 75:429, 1955. 4. Dworken, H. J.; Roth, H. P.; Herbert, C. D., and Berger, D. C.: Observations on the Course of Benign Gastric Ulcer and Factors Affecting Its Prognosis , Gastroenterology 33:880, 1957. 5. Flood, C. A., and Hennig, G. C.: Recurrence in Gastric Ulcer Under Medical Management , Gastroenterology 16:57, 1950. 6. Hayes, M. A.: The Gastric Ulcer Problem , Gastroenterology 24:609, 1955. 7. Jordan, S.: Gastric Ulcer and Cancer , Gastroenterology 34:254, 1958. 8. Macdonald, I., and Kotin, P.: Biologic Predeterminism in Gastric Carcinoma as a Limiting Factor of Curability , Surg. Gynec. & Obst. 98:148, 1954. 9. Ransom, H. K.: Subtotal Gastrectomy for Gastric Ulcer: A Study of End Results , Ann. Surg. 126:633, 1947. 10. Smith, F. H.; Bowles, R. S., Jr., and Jordan, S.:: Review of the Problem of Gastric Ulcer , J.A. M. A. 153:1505, 1953. 11. Stout, A. P.: Tumors of the Stomach , in Atlas of Tumor Pathology. Sect. 6, FASC 21, U. S. Armed Forces Institute of Pathology, National Research Council, 1953. 12. Stout, A. P.: Superficial Spreading Type Carcinoma of the Stomach , Arch. Surg. 44:651, 1942. 13. Stout, A. P.: Superficial Spreading Type Carcinoma of the Stomach , J. Nat. Cancer Inst. 5:363, 1945. 14. Zollinger, R. M.; Watman, R. N., and Denkewalter, F.: Should All Gastric Ulcers Be Treated Surgically? Gastroenterology 35:521, 1958.

Journal

A.M.A. Archives Surgery – American Medical Association

Published: Aug 1, 1959

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