[From membrane surgery to compartment surgery: source tracing and discriminating].

Area of Science:

• Surgical Oncology
• Anatomy
• Cancer Biology

Background:

• Traditional cancer surgery theory posits isotropic tumor spread confined by membranes, leading to extended excision and focus on tumor-free margins.
• This approach is debated due to uncertainties regarding the mesorectal fascial envelope and the feasibility of complete mesorectal excision along the 'holy plane'.

Purpose of the Study:

• To introduce and explain the compartment theory of tumor spread based on ontogenetic anatomy.
• To propose that optimal local cancer control is achieved through whole compartment resection, not solely margin width.

Main Methods:

• Review and interpretation of ontogenetic anatomy principles.
• Application of compartment theory to explain existing surgical practices like total mesorectal excision (TME).

Main Results:

• Compartment theory suggests tumor spread is locally confined within developmental compartments, not isotropic.
• Tumor spread is suppressed by compartment boundaries rather than fascia.
• This model explains TME as the resection of the complete rectum compartment.

Conclusions:

• Ontogenetic compartment theory offers a new paradigm for surgical tumor treatment.
• The principle is to resect the entire tumor-bearing compartment, irrespective of margin width.