We can trace no connection between the time of the return and the extent of the disease removed when the removal has been complete; and the microscopic reports are too few for general conclusions to be drawn from them. I know of no writers, except Stimson and Holmer, who have made a careful study of the specimens excised, and have given the results; and, so far as the clinical reports of the German operators go, they would seem to give support to their practice of removing everything involved, no matter how extensive, in the hope that the local return may be long delayed. When the disease reaches above three inches from the anus, or involves neighboring parts so as to render its entire removal without injury to the peritoneum questionable, the operation is contra-indicated. The Germans have apparently no limits to the applicability of this operation. They perform it in cases of the most extensive disease, opening the peritoneum, exsecting the sacrum when necessary to reach its upper limit, and removing the prostate and base of the bladder when they are implicated, balancing the risk of immediate death from the operation against the chance of radical cure, or prolonged immunity from return. Conservative surgeons will hesitate long before accepting this view, for, although very satisfactory results have been obtained in such cases, they can hardly be considered other than exceptional, and a study of cases shows that the frequency of the fatal result is in direct proportion to the extent of the operation attempted.
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