Gong Jian-ping
Department of Gastrointestinal Surgery, Tongji Hospital, Huazhong Science and Technology University Tongji Medical School, Wuhan 430030, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2013 Feb;16(2):109-10.
The local-regional recurrence is the most important failure reason of D2 radical operation for curative advanced gastric cancer. Another way of metastasis, which exists in the mesogastrium and separates apart from the primary tumor, blood vessels and lymph nodes, appears to be responsible for the local-regional recurrence partly. We call it as the fifth route of metastasis. The mesogastrium is surrounded by proper fascia completely and covered partly by serosa. We suggest that D2 radical operation should not only include the resection of primary tumor and lymphadenectomy, but also add the complete mesogastric excision (CME) as the third principle in gastric cancer radical operations to cut down the fifth metastasis route of gastric cancer, to prevent the fifth metastasis scattered on the field of operation which may induce the local-regional recurrence.
局部区域复发是进展期胃癌D2根治性手术最重要的失败原因。另一种转移途径存在于胃系膜中，与原发肿瘤、血管和淋巴结分离，似乎部分导致了局部区域复发。我们将其称为第五转移途径。胃系膜完全被脏腹膜所包绕，部分被浆膜覆盖。我们建议，D2根治性手术不仅应包括原发肿瘤切除和淋巴结清扫，还应增加完整胃系膜切除术（CME）作为胃癌根治性手术的第三条原则，以减少胃癌的第五转移途径，防止第五转移在手术野播散而导致局部区域复发。
