Growth rate of tumours

✍ Scribed by C. J. Pritchett; S. Y. Coleman; A. Fiennes

• Publisher: John Wiley and Sons
• Year: 1988
• Tongue: English
• Weight: 156 KB
• Volume: 75
• Category: Article
• ISSN: 0007-1323
• DOI: 10.1002/bjs.1800750637

✦ Synopsis

Sir

I concur with your leading article concerning perforated duodenal ulcer (Br J Surg 1987; 74: 81-2). The implication that unnecessary definitive surgery in the acute state of management should be avoided must be correct; but why not take the argument one step further?

The overall mortality rate today for patients with perforated peptic ulcer treated surgically is approximately'4 5 per cent. This is of the same order as that reported for conservative management in 1956'.

A recent prospective randomized trial of non-operative uersus operative treatment for perforated duodenal ulcer6 has demonstrated the possibility of treating certain groups of patients by non-operative means.

Such a treatment regimen would allow the subsequent definitive surgery to be undertaken on a properly selected group of patientsat time of relapse during medical therapy. Using this regimen as many as 75 per cent6 of all patients suffering perforation of a duodenal ulcer may completely escape the need for surgical intervention.