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DOI: 10.1055/s-0042-1743587
Anatomy of the Mesentery
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Abstract
It is clear that despite the importance of multimodal therapy, the most impactful weapon in the arsenal of treatment in a patient with colorectal cancer is high-quality surgery. This has been shown time and time again and surgery remains the bedrock in the management of visceral, and particularly colorectal, cancer. The reason for this is an anatomical one, based upon embryological planes. One cannot truly understand and perform high-quality surgery without an appreciation of the fascial and mesenteric anatomy of the abdomen and pelvis.
R. J. (“Bill”) Heald greatly advanced the management of rectal cancer with his description of the anatomical foundation of total mesorectal excision. He popularized usage of the term “mesorectum” and was an early pioneer in the commitment to mesenteric-based surgery. This concept has been extended by Werner Hohenberger to mesocolic excision for colon cancer surgery.
These all rely on the principle that, in general, cancer tends to remain within its embryological compartment of origin, making it amenable to dissecting out as an oncological surgical envelope or package. There have been some theories put forth as to why, but it remains the fact that, far more often than not, an excision within the mesenteric plane affords better outcomes than the one that breaches it.
Thus an understanding of the anatomy of the mesentery is important and is the scientific foundation of the art that is cancer surgery.
Herein the author outlines the history of the development of our understanding of mesenteric anatomy and where we are today.
Keywords
mesentery - anatomy - total mesorectal excision - complete mesocolic excision - colorectal cancerPublication History
Article published online:
13 April 2022
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References
- 1 Cancer Research UK. Cancer mortality for common cancers. 2018 . Accessed January 19, 2022 at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/mortality/common-cancers-compared#ref
- 2 Bunni J. The primacy of embryological, ontogenetic and specimen orientated (mesenteric) surgery as the most important tool in treating visceral (colorectal) cancer. Mesentery Peritoneum 2017; 1: 3
- 3 Heald RJ. The ‘Holy Plane’ of rectal surgery. J R Soc Med 1988; 81 (09) 503-508
- 4 Bunni J, Coffey JC, Kalady MF. Resectional surgery for malignant disease of abdominal digestive organs is not surgery of the organ itself, but also that of the mesenteric organ. Tech Coloproctol 2020; 24 (07) 757-760
- 5 Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation–technical notes and outcome. Colorectal Dis 2009; 11 (04) 354-364 , discussion 364–365
- 6 Culligan K, Walsh S, Dunne C. et al. The mesocolon: a histological and electron microscopic characterization of the mesenteric attachment of the colon prior to and after surgical mobilization. Ann Surg 2014; 260 (06) 1048-1056
- 7 Byrnes KG, Walsh D, Dockery P, McDermott K, Coffey JC. Anatomy of the mesentery: Current understanding and mechanisms of attachment. Semin Cell Dev Biol 2019; 92: 12-17
- 8 Mike M, Kano N. Laparoscopic surgery for colon cancer: a review of the fascial composition of the abdominal cavity. Surg Today 2015; 45 (02) 129-139
- 9 Culligan K, Remzi FH, Soop M, Coffey JC. Review of nomenclature in colonic surgery–proposal of a standardised nomencla-ture based on mesocolic anatomy. Surgeon 2013; 11 (01) 1-5
- 10 Coffey JC, Sehgal R, Culligan K. et al. Terminology and nomenclature in colonic surgery: universal application of a rule-based approach derived from updates on mesenteric anatomy. Tech Coloproctol 2014; 18 (09) 789-794
- 11 West NP, Morris EJA, Rotimi O, Cairns A, Finan PJ, Quirke P. Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. Lancet Oncol 2008; 9 (09) 857-865
- 12 FIPAT. Terminologia Anatomica. 2nd ed. Available at: FIPAT.library.dal.ca. . Accessed January 19, 2022. Federative International Programme for Anatomical Terminology, 2019
- 13 Rodríguez-Luna MR, Guarneros-Zárate JE, Tueme-Izaguirre J. Total mesorectal excision, an erroneous anatomical term for the gold standard in rectal cancer treatment. Int J Surg 2015; 23 (Pt A): 97-100
- 14 Dattani M, Santiago I, Mahadevan V, Heald RJ. The mesorectum and mesocolon - making sense of words. Int J Surg 2016; 36 (Pt A): 390-391
- 15 Coffey JC, O'Leary DP. The mesentery: structure, function, and role in disease. Lancet Gastroenterol Hepatol 2016; 1 (03) 238-247