Present status of operations for cancerous uteri / Howard A. Kelly.

  • Howard Atwood Kelly
Date:
1900?]
Catalogue details

Licence: In copyright

Credit: Present status of operations for cancerous uteri / Howard A. Kelly. Source: Wellcome Collection.

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    bladder before it has extended far many other direction; here good surgery will readily sacrifice and repair the entire affected vesical area, leaving it sticking to the cervix uteri. The posterior extension of the cancer, in the earlier operable stages of the disease, is fortunately rare, as it is peculiarly difficult to meet this complication with any¬ thing like a real radical operation. Almost all cases of involvement of the bowel are also associated with an extensive lateral involvement. The lateral extensions of cancer of the cervix to the right and to the left, out through the bases of the broad ligaments, surrounding the ureters, reaching to the pelvic walls, involving the pelvic and the iliac glands, are by far the most important because the most frequent and the most difficult to meet therapeutically. I think we have all agreed so far, and my dicta will have aroused no opposition, but here we meet our first crux, here opinions are widely divergent. What is the mode of this lateral extension ? Is it per continuitatem, or is it per saltum ? Is there a direct steady progression of the disease from the cervix out into the neighboring and from there into the contiguous tissues ? Or should we expect to find beyond the manifest disease, a zone of sound tissue, and then isolated foci of disease in the tissues or in the glands ? It is at once manifest that ac¬ cording as we hold one or the other of these opposing views, our surgical procedures will vary widely. For the sake of comparison let me cite the operations for cancer of the breast. Under the old idea that the dis¬ ease was localized in the breast the surgical measures were limited to its amputation. Now the knowledge that the disease jumps from the breast into the axilla and from the axilla into the neck has completely trans¬ formed the surgery of this region. Attracted by an apparent analogy between cancer of the breast and cancer of the uterus, and believing that the frequent recurrences were due in large measure to glandular metastases, there was worked out in my clinic several years ago, by Dr. S. G. Clark, a most ingenious operation, in which the uterine artery was tied back at its origin and the tissues between this and the cervix, together with the glands, were all removed, in addition to dissecting out and removing pelvic and iliac glands.