Surgical training: the private hospital, the medical school, and the federal government, 1978

Abstract

Two years before the founding of the Southwestern Surgical Congress, Dr. Thomas G. Orr, Professor and Chairman of the Department of Surgery at the University of Kansas School of Medicine, and the man honored by this lectureship, read a paper reporting a technic he had used for complete removal of the stomach for cancer and restoration of the continuity of the alimentary tract in five successful operations. Total gastrectomy, and a variety of esophagoenteric anastomoses, were and have been done both before and after Dr. Orr’s work by a number of illustrious surgeons. Slides taken from Dr. Orr’s article published in the Archives of Surgery in 1947 [I] illustrate some of the technics devised before his presentation. Since that time, a number of thoughtful surgeons have demonstrated imagination, ingenuity, and talent in an effort to create a satisfactory substitute gastric pouch, using segments of both small and large bowel. Drs. Path 121, Wilkinson, Simms, and Williamson [3], and Hunnicut [4], to name a few in this congress, have separately published articles on this subject to document their efforts. Although the mortality statistics in gastric cancer have improved due to a better understanding of pre-, intra-, and postoperative alterations in the patient’s physiologic processes, particularly in the face of concomitant disease, the question remains today whether any type of esophagoenterostomy after total gastrectomy has significantly improved the nutrition or comfort of the patient over the fundamental