[Reflection on the progress of surgical thought].
Ninety years have passed since the Japan Surgical Society was founded in 1899. During this period the development of surgery was unparalleled. What was the basis of this development? In this paper I take up surgery for gastric cancer as an example of the progress of surgical thought. The reason is gastric cancer has been the consecutive theme of the general meeting of The Japan Surgical Society. The history of surgery for gastric cancer in Japan, which started from the report of two gastric resections by Prof. Tsugushige Kondo, means the history of the progress of surgery in Japan. How did the pioneers of gastric surgery think? How did they resolve surgical problems? Furthermore, what kind of influence did they receive from the surgeons in the other fields? How did they digest it and how did they link it to the progress of surgery? Conversely, what kind of influence did they give other fields? I discuss here the lymphadenectomy for surgery of gastric cancer as an example. The base of the so-called preventive lymphadenectomy derives from the systematic radical abdominal hysterectomy for cancer of the cervix uteri. Since gastric cancer surgery started with the first gastric resection in 1897, it has been followed by lower esophagocardiectomy, total gastrectomy with jejunal interposition, combined resection of the common hepatic artery for thorough lymphadenectomy prior to Appleby, Nakayama's modification of Billroth-I and an extended radical operation. As the result of these surgeons' efforts, gastric cancer surgery with rational lymphadenectomy is now established as we claimed. I would like to reflect upon this history which was the progress of surgical thought.(ABSTRACT TRUNCATED AT 250 WORDS)
Sakakibara
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First Department of Surgery, Juntendo University School of Medicine, Tokyo, Japan.
D006801:Humans; D007564:Japan; D008197:Lymph Node Excision; D013274:Stomach Neoplasms / Q000601:surgery; D013514:Surgical Procedures, Operative / Q000639:trends*