Further surgical management of gastric ulcer with unsuspected malignant change.

This paper considers the further surgical management of patients who have had a gastric ulcer removed which was apparently benign but which on subsequent histological examination has proved to be a carcinoma. A retrospective review of 59 such patients has been undertaken. A non-radical partial gastrectomy was performed in the first instance on all these patients; 24 of them had a second operation once the correct diagnosis had been reached and 35 had no further surgery. These two groups are compared. The overall 5-year survival in the non-revisional group was only 23% compared with 56% in those treated by a second operation. It is thought that revisional surgery should be undertaken within 6-8 weeks, provided the age and general condition of the patient are satisfactory. Since 1970 the routine use of fibreoptic endoscopy and biopsy has virtually eliminated the problem.