Total gastrectomy is no longer a surgical curiosity, but because of its technical difficulties it may never become commonplace. Relatively few patients are encountered in whom the indications for the operation accepted at present are fulfilled. These indications are: first, disease of the stomach endangering life; second, such extensive involvement of the stomach that nothing short of total gastrectomy will serve to eradicate the disease, and third, confinement of the disease to the stomach alone. The practicability of the operation is determined by the mobility of the stomach and the esophagus and by the general condition of the patient. A malignant neoplasm of the stomach is ordinarily the only disease which necessitates total gastrectomy.
The anatomy of the stomach is such that the organ offers a ready path for the spread of malignant cells from each part to every other part. The muscular distribution, the vascular channels, the lymphatic pathways
MORTON CB. TOTAL GASTRECTOMY: INDICATIONS FOR OPERATION WITH A REPORT OF FOUR CASES. Arch Surg. 1942;44(1):72–80. doi:10.1001/archsurg.1942.01210190075009
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