Universalization of the operative strategy by systematic mesogastric excision for stomach cancer with that for total mesorectal excision and complete mesocolic excision colorectal counterparts

Abstract

Gastrointestinal cancer surgery aims at en bloc removal of the primary tumor with its lymphatic drainage by excising organ‐specific mesentery as an “intact package”. This concept was advocated in colorectal cancer surgery as total mesorectal excision (TME) or complete mesocolic excision (CME) procedures, but is not directly applicable to stomach cancer as a result of the morphological complexities of the gastric mesentery. In this review, we discuss the unique anatomical features of the mesogastrium by introducing its embryology, disclose its similarity to the mesosigmoid, and then propose a theoretical concept to mesentery‐based D2 gastrectomy, namely systematic mesogastric excision, which can universalize the operative strategy of stomach cancer with that of TME and CME colorectal counterparts.

Mesenteric excision for esophageal cancer surgery: based on the concept of mesotracheoesophagus

“…The concept of TME is based on sharp dissection following the anatomical planes to remove the target mesentery, including the tumor-bearing organ, from the parietal plane [10]. The same concept concerning the embryologic development of the stomach has also been accepted for gastric cancer surgery [3,4]. In radical gastrectomy, preservation of the pancreas, spleen, liver, and their corresponding feeding arteries from mesogastrium has been proven to allow safe and feasible D2 LN dissection [11][12][13].…”

“…Mesenteric excision encompasses well-known procedures, such as complete mesocolic excision for colon cancer and total mesorectal excision (TME) for rectal cancer [1,2]. The same principle has also been accepted for gastric cancer surgery after studying the embryologic foregut development [3,4]. Conversely, the principle of mesenteric excision as radical surgery for esophageal cancer has not been widely accepted, possibly because of an incomplete understanding of embryologic foregut development and the mesentery around the esophagus, which may be because of the complex surgical anatomy in the mediastinum.…”

Deep Learning in Laparoscopic Colorectal Carcinoma Surgery under Magnetic Resonance Imaging

“…To reduce the recurrence rate of postoperative local lesions of patients with advanced CRC, Bahadoer et al [12] and Shinohara et al [7] put forward TME and CME based on embryology theory in 1982 and 2009, respectively, both of which proposed reasonable and effective anatomical theories and surgical pathways for CRC surgery. Birbeck et al [13] studied 608 patients with rectal cancer and found that CRM can not only reduce the probability of local recurrence of CRC but also was a strong predictor of the overall survival rate of patients.…”

“…e tumor and its mesangial membrane can be completely removed by following this surgical plane, and the adjacent organs, blood vessels, and autonomic nerve plexus in the pelvic cavity can be avoided as much as possible [6]. Shinohara et al [7] studied and analyzed embryological and anatomical theories similar to TME in 2009 and published the concept and technique of complete mesocolic excision (CME). It provided the correct anatomical level and surgical approach for the reasonable operation of colon cancer.…”

Cause of recurrent laryngeal nerve paralysis following esophageal cancer surgery and preventive surgical technique along the left recurrent laryngeal nerve

“…Thermal injury occurred relatively early in the surgery and can be prevented by examining the location of the nerve by IONM. In recent years, mesentery-oriented lymph node dissection has become commonplace and has been proposed for esophagectomy [16] . Accordingly, we dissected the lymph nodes after mesenterization [6,8] .…”