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It must not be assumed that every cancer of the rectum is operable by, or demands the same method. The procedure which will enable us to remove the tumor thoroughly in the least possible time and with the smallest degree of shock should be the one selected in each individual case. The elements in the production of shock consist in the length of time the patient is under the anesthetic, the size of the incision and the hemorrhage incurred. The exhaustion which follows the operation will depend largely upon the amount of surface left to granulate, and from which suppuration will necessarily take place. It is most important therefore to leave as small an area of such surface as is possible in every case. When the tumor does not involve more than the lower inch and one-half of the rectum, it may be easily dissected out from below
TUTTLE JP. CANCER OF THE RECTUM.WHAT HAS MODERN SURGERY ACCOMPLISHED IN ITS TREATMENT?. JAMA. 1897;XXVIII(14):640–648. doi:10.1001/jama.1897.02440140016002h
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