[D2 gastrectomy and complete mesentery excision based on metastasis IIIII( and membrane anatomy]

D2 procedure, which includes dissection of the lymph nodes and adipose tissue in the field, has been widely accepted as a standard for curative gastric cancer surgery. However, there is no description for the boundary of these adipose resection in D2 procedure protocol so far. We found that there was a membranous tissue plane which enveloped the stomach, blood vessels, lymphatic and adipose together, and suspended them to the posterior wall of abdomen. This structure is consistent with the definition of the mesentery and we call it the mesogastrium, indicating a metastasis V in it. The precise D2 procedure should include the complete mesentery excision based on membrane anatomy, which may lead to less bleeding, more complete dissemination.