Resectional surgery for malignant disease of abdominal digestive organs is not surgery of the organ itself, but also that of the mesenteric organ
Autor: | John Calvin Coffey, J. Bunni, Matthew F. Kalady |
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Jazyk: | angličtina |
Rok vydání: | 2020 |
Předmět: |
Embryology
medicine.medical_specialty Colorectal cancer medicine.medical_treatment Connective tissue Malignancy 03 medical and health sciences 0302 clinical medicine D3 lymphadenectomy medicine Humans Mesentery Colectomy Central vascular ligation (CVL) business.industry Controversies in Colorectal Surgery Gastroenterology medicine.disease Total mesorectal excision Colorectal surgery Surgery medicine.anatomical_structure 030220 oncology & carcinogenesis Colonic Neoplasms Lymph Node Excision Ontogenetics Laparoscopy 030211 gastroenterology & hepatology Lymphadenectomy Ligation business Mesocolon Complete mesocolic excision (CME) Abdominal surgery |
Zdroj: | Techniques in Coloproctology |
ISSN: | 1123-6337 |
Popis: | Despite large strides in molecular oncology, surgery remains the bedrock in the management of visceral cancer. The primacy of surgery cannot be understated and a mesenteric (i.e. ontogenetic) approach is particularly beneficial to patients. Heald greatly advanced the management of rectal cancer with his description of the anatomical foundation of total mesorectal excision (TME), dramatically improving outcomes worldwide with this mesenteric-based approach. Moreover, complete mesocolic excision (CME) based on similar principles is becoming popular. Introduced by Hohenberger, CME resembles TME insofar as it emphasises strictly anatomical dissection along embryological planes to detach an intact (i.e. “complete”) mesentery with peritoneal envelope. CME also incorporates “central” vascular ligation (CVL) which broadly correlates with the “D3 lymphadenectomy” of Eastern literature. As many surgeons already practise anatomical and mesenteric-based surgery, it is unclear how the putative benefits of CME (including CVL) arise. Herein, we argue that these may relate to a more extensive resection of the mesentery, and thus mesenteric tumour deposits within the connective tissue lattice of the mesentery, and not necessarily the lymphadenectomy alone. We believe the connective tissue interface between the bowel wall and mesentery provides an alternative mode of spread of pathogenic elements. Whilst this remains a suggestion only, it would explain the histological independence of tumour deposits and why a greater mesenterectomy could be associated with benefits in survival. If this argument holds, it follows that resectional surgery for digestive organ malignancy is not surgery of the organ itself (or lymphatics only), but also that of the contiguous mesentery. |
Databáze: | OpenAIRE |
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