Department of Gastrointestinal Surgery, Tongji Cancer Research Institute, Tongji Hospital, Tongji Medical College in Huazhong University of Science and Technology, Wuhan 430030, PR China.
Med Hypotheses. 2013 Apr;80(4):498-500. doi: 10.1016/j.mehy.2012.12.020. Epub 2013 Feb 10.
Radical gastrectomy for gastric cancer with D2 lymph node dissection has been widely applied in advanced gastric cancer. It is believed that such surgery should extremely sweep away local-regional tumor tissues and cancer cells and thoroughly prevent tumor recurrence in situ. However, for most patients with advanced gastric cancer, tumor local-regional recurrence has been proven unavoidable. This study has found that isolated cancer cells, separate from the primary lesion and lymph nodes, existed in the mesogastrium of resected gastric cancer specimens, leading to the hypothesis that these cancer cells may have infiltrated the mesogastrium through a fifth metastasis route (here named Metastasis V) which is distinct from the other four classic metastasis routes, and cannot be resected by conventional radical gastrectomy with D2 lymph node dissection. Local-regional recurrence might be closely associated with these cancer cells in the mesogastrium, and therefore, complete mesogastrium excision (CME) should be imperative and become the third radical principle for radical gastrectomy.
胃癌的根治性胃切除术加 D2 淋巴结清扫术已广泛应用于进展期胃癌。人们认为，这种手术应该彻底清除局部区域的肿瘤组织和癌细胞，并彻底防止原位肿瘤复发。然而，对于大多数进展期胃癌患者，肿瘤局部区域复发已被证明是不可避免的。本研究发现，在切除的胃癌标本的胃系膜中存在与原发灶和淋巴结分离的孤立癌细胞，这导致了这样一种假设，即这些癌细胞可能通过第五种转移途径（命名为转移途径 V）渗透到胃系膜中，这种转移途径与其他四种经典转移途径不同，不能通过常规的根治性胃切除术加 D2 淋巴结清扫术切除。局部区域复发可能与胃系膜中的这些癌细胞密切相关，因此，完全胃系膜切除术（CME）应该是必要的，并成为根治性胃切除术的第三个根治原则。
