Medicine: The Nonessential Stomach

A human being can live—after a fashion —minus his stomach, his pancreas and half his liver. How much can he lose and still survive? A noted cancer surgeon last week offered some startling new data on that old question.

Dr. Alexander Brunschwig, of the University of Chicago, specializes in operating on cancer patients given up as inoperable by other surgeons. His drastic operations, he admits, rarely cure, but they usually make the patient more comfortable, often prolong life for years. In a clinical report published last week (Radical Surgery in Advanced Abdominal Cancer; University of Chicago Press; $7.50), Dr. Brunschwig described "the most radical [successful] operation yet recorded."

The 28-year-old patient had a huge tumor that had engulfed his stomach and part of his upper abdomen. Dr. Brunschwig removed: 1) the stomach, 2) half the left lobe of the liver, 3) the body and tail of the pancreas, 4) the spleen, 5) the transverse colon (a section of the large intestine), 6) part of the abdominal wall. Then he connected the esophagus with what was left of the intestinal tract. The patient, left with only part of the intestines to serve as a digestive system, was "quite comfortable" after the operation, "enjoyed his food" (eaten in small, hourly feedings). He lived eight weeks, died not from the operation but from the spreading cancer.

Is life worth living after such a drastic operation? Dr. Brunschwig, taking issue with many doctors, answers an emphatic yes. At worst (if the patient survives), such surgery relieves suffering; at best, it may restore a hopeless, lingering invalid to useful work and a nearly normal life.

Of 100 "hopeless" patients who submitted to Dr. Brunschwig's radical surgery, 34 died within a month. But 49 were greatly helped; of these 19 are still alive, one to ten years after their operations. Among them: a 50-year-old laborer who can do a full day's work though he lacks stomach and spleen.

Brunschwig's methods include massive transfusions (as much as twelve pints of blood and plasma in some cases) and big liquid feedings by injection, before & after the operation. Most of the functions of the stomach, pancreas and some other organs, Brunschwig points out, can be performed by substitutes: a section of intestine takes the place of the stomach, a thin slice of pancreas left in the body, or injections, can supply the body's insulin needs.

Brunschwig's conclusion: a man could probably survive with part of one adrenal gland, part of the liver, about 30% of the small bowel, one kidney, a few other abdominal odds & ends.