Wang G J
Department of Gastrointestinal Surgery, Zhengzhou University First Affiliated Hospital, Zhengzhou 450052, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2024 Sep 25;27(9):904-908. doi: 10.3760/cma.j.cn441530-20240710-00241.
This study elaborates the essence of distant lymph node metastasis and skip metastasis of esophageal cancer according to the membrane anatomy theory. Lymph distant metastasis of esophageal cancer is essentially the phenomenon of cancer cells shedding from the primary focus of esophageal cancer and transferring along the direction of lymphatic drainage to the root of the esophageal mesentery. Because the metastasis is relatively distant, it is called distant metastasis. Despite the long distance, this metastasis is still limited to the envelope-like-membrane structure of the esophageal mesentery and belongs to the category of mesangial carcinoma. The lymph node skip metastasis of esophageal cancer refers to the process in which esophageal cancer cells detach from the primary lesion and migrate along the lymphatic drainage direction within the envelope-like-membrane structure of the mesentery to the central lymph nodes at the root of the mesentery. During this metastatic process, the surrounding mesenteric lymph nodes which are tightly attached to the esophagus will not be affected by cancer metastasis because of the isolation barrier effect of the envelope-like membrane structure of the esophageal mesentery. Applying the theory of membrane anatomy to esophageal cancer radical surgery will make the surgery more scientific, reasonable, and standardized, and is expected to achieve dual benefits of both surgical and oncological effects in esophageal cancer radical surgery.
本研究依据膜解剖学理论阐述了食管癌远处淋巴结转移及跳跃转移的本质。食管癌的淋巴远处转移本质上是癌细胞从食管癌原发灶脱落,并沿淋巴引流方向转移至食管系膜根部的现象。由于转移距离相对较远,故称为远处转移。尽管距离较远,但这种转移仍局限于食管系膜的包膜样膜结构内,属于系膜癌范畴。食管癌的淋巴结跳跃转移是指食管癌细胞从原发灶脱离,在系膜的包膜样膜结构内沿淋巴引流方向迁移至系膜根部的中央淋巴结的过程。在此转移过程中,由于食管系膜包膜样膜结构的隔离屏障作用,紧密附着于食管的周围系膜淋巴结不会受到癌转移的影响。将膜解剖学理论应用于食管癌根治手术,会使手术更加科学、合理、规范,有望在食管癌根治手术中实现手术效果与肿瘤学效果的双重获益。