NE OF THE MOST IMPORTANT gauges of suc-0 cess in surgery is the yardstick by which we would all be measured: the survival of the patient. Regardless of all else, if the patient does not live, there must always remain an element of doubt in the surgeon's mind as to the soundness of his judgment and technique.
T h e fact that he deals with a disease of such lethal potentialities as cancer does not condone carelessness either in his estimation of a patient's ability to withstand a major surgical attack or the performance of the operative procedure itself. T h e postoperative management of such patients requires a constant vigilance that must never be relaxed.
In the treatment of gastric cancer all these elements must be especially kept in mind. T h e age of the patient, the inanition caused by varying degrees of starvation, the concomitant degenerative processes in many elderly subjects, along with the magnitude of the surgical approach to the problem, combine to tax all our resources. T h e medical consultant is not asked if the patient can withstand the opera--tion, but how rapidly will it be possible to have him ready. In dealing with cancers of the intra-abdominal digestive tract, there is no second choice in modalities of treatment: surgical extirpation alone offers help to the sufferer. Because of the subdiaphragmatic location of the stomach and the fact that both abdominal and thoracic cavities must frequently be opened in order to facilitate the complete removal of cancers of this organ, complications peculiar to both spaces must be anticipated.
Statistical analyses of large series of patients treated in the foremost clinics in this country and elsewhere have made it quite clear that a small but definite percentage of patients may hope for cure after subtotal gastrectomy. Realizing that a study of surgical failures might clarify some of the causes giving rise to the gloomy prognosis offered by com-
From the Gastric