IT IS POSSIBLE that total gastrectomy is the treatment of choice in all carcinomas of the stomach.1 Because of the excessive gravity of this suggestion, its worth should be critically evaluated from every possible angle before it is generally adopted.
A mere philosophy of radicalism is not sufficient. The concept of removing the entire substance of any nonvital organ harboring cancer is not necessarily valid. This concept carried to the point of absurdity would suggest the removal of the entire face for a small basal cell carcinoma. A more valid, and probably more radical over-all concept, is that of removing all areas suggested by the known pathologic characteristics of a given malignant lesion.
Strict observance of the pathologic aspects of malignancy has seldom failed to bear surgical fruit. This is true regardless of whether it leads to a more conservative or a more radical operation. In any historical review