The author operated on a 54 year old male patient suffering from gastric cancer and performed subtotal gastrectomy combined with partial duodeno-pancreatectomy in one stage. This patient died on the 10th postoperative day under the picture of biliary peritonitis.
From the technical point of view he summarizes as follows:
1) With sufficient preparation, this surgical procedure is not so hazardous, but surely a major operation so far. This operation needed 6 hours in this case. During the operation 1600gm blood was transfused with sufficient effects and there was no signs of shoc.
2) In this case the most difficult part of the procedure was to clear out the lymph nodes at the root of the left gastric artery and before the aorta.
3) Total duodenectomy is to be prefered to partial duodenectomy, and end to end anastomosis of jejunum and pancreatic stump is recommended.
4) The communication modus the biliary and the alimentary tract is an imporant problem. the choledochojejunostomy is probably the best one, but such a device as continuous drainage through anastomosis-ring, intestinal and abdominal wall like Witzel enterostamy may be needed for a few days after operation in order to prevent contamination by content leakage.
5) We heve experiences of local recurrences occuring from adherred. pancreas after the radical gastrectomy by blunt dissection of adhesion between the gastric tumor and the pancreas. In Such cases we may be sure to get permanent cure only by the gastro-dusdens-pancreatectomy once in a while in the near future.

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