Duodenal Extension of Carcinoma of the Stomach.

With respect to the significance of duodenal extension of stomach cancer in practical surgery, 833 stomach specimens obtained by subtotal gastrectomy were examined histologically. The incidence of duodenal invasion was 18.1 per cent (151 cases) as a whole but as high as 37.0 per cent in the 135 cases in which the stomach tumors were 1 cm or less distant from the pyloric ring. Of the cases with duodenal invasion, the serosa of the duodenum was involved in 115 cases (76.2 per cent) but the continuous extension of carcinoma to the duodenal mucosa was observed in none; most of the former cases were those in which carcinoma extended to the duodenal serosa from the stomach serosa in the form of inci pient carcinomatous peritonitis. The 151 cases were commonly associated with cancer spreads to other structures, e.g. peritoneal invasion and lymph node metastasis, and the majority were revealed to be beyond the scope of radical surgery even when the duodenum was widely resected. However, it was also noteworthy that there were a few cases in which carcinoma of the prepyloric re gion extended to the submucosa of the duodenum at an early stage of cancer progress where no other extragastric spread was evidenced.