The objects and limits of operations for cancer : with special reference to cancer of the breast, mouth and throat, and intestinal tract : being the Lettsomian lectures for 1896 / by W. Watson Cheyne.

Watson Cheyne

Date:: 1896

Credit: The objects and limits of operations for cancer : with special reference to cancer of the breast, mouth and throat, and intestinal tract : being the Lettsomian lectures for 1896 / by W. Watson Cheyne. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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$with. 17 deatlis (50 per cent.), six early recurrences (17 per cent.), five late recurrences (12 per cent.), three remained well for from three and three-quarters to five years (8 per cent,), and the remainder cannot be classified. The total is 23 not benefited {^7 per cent.) and eight benefited (23 per cent.). Of five apparently well for three years, two subsequently recurred (40 per cent.). We may say, therefore, that of these 100 cases 61 were no better off than if they had been left alone, and not so well off on the whole as if they had had colotomy done, for 27 of them died at once. These results are not in any way better, indeed not so good as in the pharynx operations. On the other hand, 33 gained advantage, and most of them very marked advantage, from the radical operation, much greater than colotomy could have given. From this we see that of every ] 00 cases subjected to the radical operation in Grermany only about 35 are really likely to be benefited by the operation, and 60 would be better off if left alone or with colotomy, for in Grermany the radical operation is carried to an extreme extent, adhesion to bladder and prostate not even forming a contra-indication; indeed, Genzmer goes so far as to advocate the operation even though there are already metastatic deposits in the liver. As even in Grermany, about 20 per cent, to 25 per cent, of the cases applying for relief are not deemed fit for the radical operation, we may say that, taking all patients together as they come to the surgeon, not more than 20 per cent, will be benefited by the radical operation; the remainder will do better left alone or with colotomy. If we study the successful cases, it appears that in the great majority of instances where real benefit was derived from the operation, the disease was low down and was not adherent to surrounding structures : the cases of success as regards prolonged freedom from recurrence where the disease was high up or adherent to surrounding structures such as the prostate, are quite few in number. In this matter I quite agree with the tendency of the English school of surgery as opposed to the German, and would exclude from the radical operation cases of rapid growth ; cases where the disease forms large masses in the intestine or is deeply ulcerated; cases where it has passed through the wall of the rectum and invaded surrounding parts, as indicated by fixidity ; and rapidly growing tumours high up, even though not yet fixed. In none of these is there any real prospect of cure, or of marked prolongation of life. In the fixed tumours, local recurrence is$