Radical surgery for gastric cancer is becoming increasingly standardized and rationalized, but there is a lack of a fully unified concept, making a lack of consistent criteria for assessing surgical efficacy. Here we summarize the latest advances in gastric cancer surgery and firstly propose total gastric mesenteric resection for gastric cancer for your discussion. Total gastric mesenteric resection must be based on a strong scientific foundation and a deep understanding of the relationship between the stomach and its lymphatic reflux and peritoneal reflex from embryogenesis and anatomy. I. Definition and components of the gastric tract The liver, spleen and pancreas are all derived from the gastric tract during embryonic development, so in a broad sense the liver, spleen and pancreas are part of the gastric tract. In a narrow sense, the gastric mesentery is the perigastric ligament and fused fascia that connects the stomach to the surrounding organs and abdominal wall. II. Definition of total mesenteric resection and its necessity for the treatment of gastric cancer Total mesenteric resection refers to the complete removal of all tissue structures within the ventral and dorsal mesentery of the stomach, including the stomach and its blood vessels and lymphatic adipose tissue. Strictly speaking, the pancreas and spleen are also organs within the gastric mesentery, but only the function of the spleen is less important. Total mesenteric resection of the stomach can be considered as splenic artery and vein, splenic and/or left hemipancreatic resection. The perigastric mesentery is superficially unrelated, but is embryologically continuous. The stomach is closely related to lymphatic and neural structures, and the loose connective tissue between the gastric mesentery is connected to each other, and blood vessels and lymphatic vessels are within it, allowing malignant or inflammatory lesions to spread and spread along it. Therefore, lymph node dissection for gastric cancer should be performed along this pathway. The lymphatic system of the stomach is mainly accompanied by the branches of the celiac artery, and the branches of the celiac artery are located in the dorsal and ventral mesentery of the stomach, so the lymphatic dissection of radical gastric cancer should completely remove the dorsal and ventral mesentery of the stomach. The specific scope includes: the small omentum originating from the ventral mesentery, including the hepatoduodenal ligament, hepatogastric ligament and diaphragmatic gastric ligament;
The posterior wall of the omental capsule originating from the posterior layer of the dorsal mesentery, including the gastro-pancreatic and hepatopancreatic folds, the anterior pancreatic fascia and the anterior lobe of the transverse colonic mesentery fused with the posterior layer of the dorsal mesentery. In recent years, radical surgery for gastric cancer has made great progress, but good results can never be obtained by manual techniques alone, and the design of the operation is crucial. Surgeons should understand the development of stomach and surrounding organs, be familiar with the course of gastric mesentery, and use the technique of external omental bursa dissection to perform total mesenteric resection to treat gastric cancer, so as to achieve complete radical gastric cancer surgery and provide a uniform standard for evaluating the surgical results.