[Basic research and clinical applications progress of gastrointestinal developmental anatomy surgery]

Total mesorectal excision (TME), complete mesocolic excision (CME), and other mesenteric surgeries have elevated the precision of radical gastrointestinal tumor treatment. These approaches inherently align with embryonic development laws, relying on natural anatomical landmarks such as embryonically formed fascial spaces to ensure surgical safety and radicality. However, the surgical theory centered on developmental anatomy remains to be improved, currently, the mastery of surgical procedures and the determination of dissection boundaries rely more on surgeons' clinical experience than on theoretical guidance, resulting in a disconnect between clinical practice and applied theory that limits the homogeneous promotion of these surgeries. This paper proposes exploratorily the concept of gastrointestinal developmental anatomy surgery, with "reverse embryonic development" as its core logic. Based on a thorough understanding of embryonic development, it deconstructs adult anatomical complexity by retroactively deducing primitive gut rotation, mesenteric fusion, and fascia formation, enabling diseased tissue resection and functional reconstruction after restoring a primitive mesentery-like state. Centered on three principles-total mesentery excision, interruption of mesenteric blood supply, and extra-mesenteric preservation-this approach leverages embryonically formed fused fascial spaces to integrate en-bloc resection and organ function preservation. It has also been validated through radical right hemicolectomy and radical gastrectomy to clarify the role of gastrointestinal developmental anatomical surgery in defining surgical boundaries and anatomical landmarks, reducing operational difficulty, and improving the reproducibility and homogenization of surgical procedures.