The Gastric Ulcer Problem: Prognosis in Masked Malignancy

Abstract

ployed in duodenal ulcer, and the need will be apparent to all. There will remain a smaller group of patients with lesions about which a difference of opinion with respect to proposed treatment well may occur. In some of these patients a gastric ulcer may recur after initial healing, or healing may be slow, but the internist is clinically certain that the ulcer is benign. In other patients the ulcer may lie so high on the lesser curvature that opera­ tion will carry a greater than usual risk of life, or permanent, unpleasant se­ quelae. In some the total evidence will favor a diagnosis of carcinoma, although no hard and fast opinion can be rendered. In all of this group, if operation is undertaken, the diagnosis will either be benign ulcer, or it will be indeterminate. \Ve refer to malignancy found in this group as masked malignancy, even though in most instances it will have been the possibility of malignancy which prompted operation. This study proposes to evaluate factors influencing the physician who advises treatment for this last group (fig. 1). FACTORS OPPOSING OPERATION Operative mortality. In a personal series (S. O. H.) of gastric resections for benign gastric ulcers, the operative mortality has been one in 110 patients.t An operative mortality of 1 or 2 per cent is common in the experience of many