Surgery: The Most Radical Operation

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Dr. Alexander Brunschwig of Manhattan's Memorial Hospital has literally disemboweled hundreds of patients during the past 17 years. In almost every case, the list of organs he has removed would seem to be a surely lethal loss. But Brunschwig's viscerations — or pelvic exenterations, as surgeons prefer to call the incredibly drastic operations —have been a startlingly successful effort to save lives after all hope was gone.

In a newly published French monograph, L'Exentération pelvienne, Dr. Brunschwig reports that no fewer than 116 of his 562 patients have lived five years or longer after the operation. Virtually all have been glad that they submitted to the extensive amputation, even though many have had to wear a bag strapped to their waists to collect urine and feces. Some have been able to work for years, with no outward sign of their condition.

Touring & Swimming. Dr. Brunschwig, a surgeon and gynecologist, decided as long ago as 1934 that some cancer patients for whom all other treatment had failed might be kept alive for several years by operations more drastic than any so far attempted. He began, usually in cases of stomach cancer, by removing most of the stomach, half of the left lobe of the liver, the body and tail of the pancreas, the spleen, the transverse colon and part of the abdominal wall. Of the first 100 patients, 19 lived for one to ten years, including a laborer who went back to doing a full day's work (TIME, March 17, 1947).

Among women there were even more severe cases in which massive cancers had spread from uterus to large bowel and bladder, or from bowel to uterus and bladder. For them Dr. Brunschwig devised a still more radical operation, removing not only the vagina, cervix and uterus, but much of the lower colon and also the bladder. This necessitates making an artificial bladder from a section of small bowel, or leading the ure ters into the colon, which then empties both urine and feces into a "wet colostomy" bag. After more conventional operations for rectal cancer that has not spread widely, only fecal matter passes through the "dry colostomy" opening in the abdominal wall, because the bladder and urethra are left in tact. Since no two patients' diseases are alike, Brunschwig operations vary in the number of organs and length of bowel removed.

One man was well enough to make a transcontinental tour eight years after exenteration for cancer of his rectum and bladder. A woman of 35, whose operation spared the lower part of her pelvis, was having a normal sex life and went swimming seven years after surgery. Dr. Brunschwig's most extreme case was a woman who lost many internal organs, including the left kidney, plus all related lymph nodes, along with her left leg and hind quarter. Eight years later she is living happily and doing all her own housework.