An anatomical, histopathological, and molecular biological function study of the fascias posterior to the interperitoneal colon and its associated mesocolon: their relevance to colonic surgery

Abstract

The study aim was to explore the anatomy, histopathology, and molecular biological function of the fascias posterior to the interperitoneal colon and its mesocolon to provide information for improving complete mesocolic excision. To accomplish this aim, we performed intraoperative observations in 60 interperitoneal colon-cancer patients accepted for complete mesocolic excision and conducted local anatomy observations for five embalmed cadavers. An additional two embalmed child cadaver specimens were studied with large slices and paraffin sections. Ten of the 60 patients were examined with a lymph node tracer technique in vivo, while fresh specimens from these patients were assessed by histopathological examination and transwell cell migration assays in vitro. The anatomical and histopathological findings showed that the fascias posterior to the interperitoneal colon and its associated mesocolon were composed of two independent layers: the visceral and parietal fascias. These two fascias were primarily composed of collagen fibers, with the parietal fascia containing a small amount of muscle fiber. The in vivo test showed that the visceral fascia surrounded the colon and its associated mesocolon, including vessels and lymphatics, and that it had no lymphatic flow through it into the rear tissues. Moreover, the in vitro assays showed the visceral fascia was able to block tumor cell migration. Although many surgical scholars have known of the existence of fascia tissue posterior to the intraperitoneal colon, the detailed structure has been ignored and been unclear. As shown by our findings, the visceral and parietal fascias are truly formed structures that have not been previously reported. A thorough understanding of fascial structures and the function of the visceral fascia barrier in blocking tumor cells will facilitate surgeons when performing high-quality complete mesocolic excision procedures.

Complete mesocolic excision in colorectal cancer: a systematic review

“…In vivo tests have demonstrated that the visceral fascia surrounds the colon with its associated mesocolon, including vessels and lymphatics, and that it has no lymphatic flow through it into the surrounding tissues. In vitro assays have demonstrated that the visceral fascia is able to prevent direct tumour cell migration .…”

Short-Term and Long-Term Outcomes of Complete Mesocolic Excision with Central Vascular Ligation for Ascending Colon Cancer: Single Institution

“…It is important to recognize that these two layers are not limited to the pelvis but cover the entire colon as a peritoneal and retroperitoneal envelope [15,16]. The colon is surrounded by the visceral fascia and its mesocolon, including its vessels and lymphatics; therefore, there is no lymphatic flow into the tissues of mesocolon [17]. During the en bloc resection of the colon, the fascial space in the posterior lobe of the mesocolon is completely dissected to separate the fusion fascia from the visceral fascia and the parietal fascia up to the radix of the mesocolon.…”

International Guidelines for Veterinary Tumor Pathology: A Call to Action

“…The peritoneal serosa is a reported barrier to tumor cell migration in vitro. 52 Certainly, the type of tumor, grade of tumor, whether it expands circumferentially, infiltrates, or skips (discontinuous growth pattern) influences how effectively a potential tissue barrier may function. Compartments, fascial planes, and fascia vary depending on anatomical location; therefore, information about location and gross tumor growth patterns (confined, infiltrative) should be provided on the pathology requisition.…”