From membrane surgery to compartment surgery: source tracing and discriminating
10.3760/cma.j.issn.1671?0274.2019.10.004
- VernacularTitle:从膜手术到腔室手术:求源与辨析
- Author:
Moubin LIN
1
;
Hailong LIU
;
Yi CHANG
Author Information
1. 同济大学附属杨浦医院普通外科 同济大学胃肠外科和转化医学研究所
- Keywords:
Rectal neoplasms;
Total mesorectal excision;
Compartment;
Membrane anatomy
- From:
Chinese Journal of Gastrointestinal Surgery
2019;22(10):920-925
- CountryChina
- Language:Chinese
-
Abstract:
The theory of membrane surgery actually holds the same concepts as that of traditional cancer surgery, which believes that tumor spread is regarded as an isotropic process but the tumor is confined by the block of the membrane. Therefore, the radical resection can be achieved by complete mesentery excision along the membrane plane. The surgical practice derived from these conceptions is extended excision and lays emphasis on tumor?free margins. But the theory is controversial in the view of the existence of mesorectal fascial envelope and the feasibility of complete excision of mesorectum along the "holy plane". Based on ontogenetic anatomy, the compartment theory suggeststhat tumor spread is not isotropic, and it is locally confined within the ontogenetic compartment derived from a common primordium for a relatively long phase during their natural course. Local tumor is suppressed by the boundary instead of fascia. The anatomical territory developing from each anlage primordium may be separated morphologically. Consequently, ontogenetic compartment theory states that optimal local control of cancer is achieved by whole compartment resection, irrespective of margin width. The compartment model of tumor spread provides explanations for total mesorectal excision (TME) which excises the complete rectum compartment including the rectum and its surrounding vascular and ligamentous mesenteries. The compartment theory may set up the new principles for surgical tumor treatment, namely the resection of the tumor bearing compartment rather than target organ.
