Since the introduction of complete mesocolic excision(CME) for colon cancer, the oncologic outcome of patients has been greatly improved, which has led to a longer survival and a lower recurrence, just like the total ...Since the introduction of complete mesocolic excision(CME) for colon cancer, the oncologic outcome of patients has been greatly improved, which has led to a longer survival and a lower recurrence, just like the total mesorectum excision for rectal cancer. Despite the fact that the exact anatomy of the organ is one of the most vital things for surgeons to conduct surgery, no team has really studied the exact structure of the mesocolon and related attachments for CME, until the mesocolonic anatomy was first formally characterized in 2012. Therefore, this article mainly focuses on the anatomy development of the mesocolon and the achievement in this field. Meanwhile, we introduce the latest progress in laparoscopic surgery for colon cancer achieved by our team.展开更多
Preservation of the spleen at distal pancreatectomy has recently attracted considerable attention.Since our first successful trial,spleen-preserving distal pancreatectomy with conservation of the splenic artery and ve...Preservation of the spleen at distal pancreatectomy has recently attracted considerable attention.Since our first successful trial,spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein for tumors of the pancreas and chronic pancreatitis has been performed more frequently.The technique for spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein are outlined.The splenic vein is identified behind the pancreas and within the thin connective tissue membrane.The connective tissue membrane is cut longitudinally above the splenic vein.An important issue is to remove the splenic vein from the body of the pancreas toward the spleen,since a different approach may be very difficult.The pancreas is preferably removed from the splenic artery toward the head of the pancreas itself.This procedure is much easier than removing the pancreas from the vein side.One patient had undergone distal gastrectomy for duodenal ulcer,with reconstruction by Billroth Ⅱ tehcnique.If distal pancreatectomy with splenectomy had been performed for the lesion of the distal pancreas at the time,the residual stomach would also have to be resected.The potential damage done to the patient by reconstruction of the gastrointestinal tract in combination with distal pancreatectomy and splenectomy would have been much greater than with distal pancreatectomy only with preservation of the spleen and residual stomach.Benign lesions as well as low-grade malignancy of the body and tail of the pancreas may be a possible indication for this procedure.展开更多
Although total mesorectal excision has now become the‘gold standard’for the surgical management of rectal cancer,this is not so for colon cancer.Recent data,provided by Hohenberger and West et al.and others,have dem...Although total mesorectal excision has now become the‘gold standard’for the surgical management of rectal cancer,this is not so for colon cancer.Recent data,provided by Hohenberger and West et al.and others,have demonstrated excellent oncological outcomes when mesenterectomy is extensive(as is implicit in the concept of a‘high tie’)and the mesenteric package not violated.Such studies highlight the importance of understanding the basics of the mesenteric organ(including the small intestinal mesentery,mesocolon,mesosigmoid and mesorectum)and of abiding to principles of planar surgery.In this review,we first offer classic descriptions of the mesocolon and then detail contemporary thinking.In so doing,we provide an anatomical basis for safe and effective complete mesocolic excision(CME)in the management of colon cancer.Finally we list opportunities associated with the new anatomical paradigm,demonstrating benefits across multiple disciplines.Perhaps most importantly,we feel that a crystallized view of mesenteric anatomy will overcome factors that have hindered the general uptake of CME.展开更多
文摘Since the introduction of complete mesocolic excision(CME) for colon cancer, the oncologic outcome of patients has been greatly improved, which has led to a longer survival and a lower recurrence, just like the total mesorectum excision for rectal cancer. Despite the fact that the exact anatomy of the organ is one of the most vital things for surgeons to conduct surgery, no team has really studied the exact structure of the mesocolon and related attachments for CME, until the mesocolonic anatomy was first formally characterized in 2012. Therefore, this article mainly focuses on the anatomy development of the mesocolon and the achievement in this field. Meanwhile, we introduce the latest progress in laparoscopic surgery for colon cancer achieved by our team.
文摘Preservation of the spleen at distal pancreatectomy has recently attracted considerable attention.Since our first successful trial,spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein for tumors of the pancreas and chronic pancreatitis has been performed more frequently.The technique for spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein are outlined.The splenic vein is identified behind the pancreas and within the thin connective tissue membrane.The connective tissue membrane is cut longitudinally above the splenic vein.An important issue is to remove the splenic vein from the body of the pancreas toward the spleen,since a different approach may be very difficult.The pancreas is preferably removed from the splenic artery toward the head of the pancreas itself.This procedure is much easier than removing the pancreas from the vein side.One patient had undergone distal gastrectomy for duodenal ulcer,with reconstruction by Billroth Ⅱ tehcnique.If distal pancreatectomy with splenectomy had been performed for the lesion of the distal pancreas at the time,the residual stomach would also have to be resected.The potential damage done to the patient by reconstruction of the gastrointestinal tract in combination with distal pancreatectomy and splenectomy would have been much greater than with distal pancreatectomy only with preservation of the spleen and residual stomach.Benign lesions as well as low-grade malignancy of the body and tail of the pancreas may be a possible indication for this procedure.
文摘Although total mesorectal excision has now become the‘gold standard’for the surgical management of rectal cancer,this is not so for colon cancer.Recent data,provided by Hohenberger and West et al.and others,have demonstrated excellent oncological outcomes when mesenterectomy is extensive(as is implicit in the concept of a‘high tie’)and the mesenteric package not violated.Such studies highlight the importance of understanding the basics of the mesenteric organ(including the small intestinal mesentery,mesocolon,mesosigmoid and mesorectum)and of abiding to principles of planar surgery.In this review,we first offer classic descriptions of the mesocolon and then detail contemporary thinking.In so doing,we provide an anatomical basis for safe and effective complete mesocolic excision(CME)in the management of colon cancer.Finally we list opportunities associated with the new anatomical paradigm,demonstrating benefits across multiple disciplines.Perhaps most importantly,we feel that a crystallized view of mesenteric anatomy will overcome factors that have hindered the general uptake of CME.
