Special Interview

Conversation with Professor Gong Jianping， Tongji Hospital， Tongji Medical College， Huazhong University of Science and Technology┃Oncology surgery

Recently， we have invited Professor Gong Jianping， who comes from Tongji Hospital， Tongji Medical College， Huazhong University of Science and Technology， to share their research progress in the field of gastrointestinal tumors. At the same time， he also shared the application of membrane anatomy theory in tumor surgery.

Professor Gong is the deputy director of Department of Surgery， the director of General Surgery， the director of Gastrointestinal Surgery Center， the director of Cancer Research Institute， and the director of Molecular Medicine Center. He is the winner of National Outstanding Youth Fund， the special allowance recipient of the State Council， the member of external science branch of Chinese Medical Association， and the deputy leader of experimental surgery group of Chinese Medical Association. He is the chief editor of Surgery and the deputy editor of Oncology. From 1992 to 1996， he studied in New York Medical College. He has presided over a number of national key scientific research projects， and has been engaged in general surgery for more than 30 years. He is good at the surgical treatment of gastrointestinal tumors， especially the large-scale minimally invasive surgery of laparoscopic gastrointestinal surgery. He has taken the lead in proposing the concept of total mesorectal excision （D2 + CME） and "three ring" right hemicolectomy （laparoscopic right hemicolectomy D3 + CME） in the world， making gastric cancer and colon cancer and other complex gastrointestinal cancer treatment is more standardized， thorough and safe.

Interview content

1. What are the current research hotspots in the surgical treatment of gastrointestinal tumors？ Could you please share your opinion on above hotspots？

Improved oncologic results were reported by TME/CME in 1982 and 2009 respectively. However， 3 questions were left for oncologic surgery. 1） Why TME/CME could improve oncologic outcome of colorectal cancer， even in patients without lymph node metastasis， even the TME/CME field were less than traditional D3？ 2） What is the holy plane？ What is the membrane （fascia membrane or serous membrane）？ What is essential role of the mesentery？ 3） Is there only mesentery in the bowel？ Is the mesentery independent of the bowel？ To answer these questions， a brand new field， membrane anatomy， is emerging.

2. What researches are you doing recently related to the surgical treatment of gastrointestinal tumors？ Is there any latest progress？

GI cancers are the leading cause in cancer patients worldwide. Surgical hazards and local regional recurrence are both decreased survival rate of the patients. For answer questions above and improve surgical and oncologic results， we start researches on anatomy and pathology of the gastric cancer and colon cancer. Followed structure definition of a mesentery and under conditions of laparoscopic （macro） combined with tissue section （micro）， we found that it was wrong that the bursa sac and greater omentum are mesogastrium as traditional concept described. The real mesogastrium in the D2 field is the proximal segment of dorsal mesogastrium （PSDM） actually， the form as a table model， even the distal segment of it has no controversy. In it， there are not only feeding structure and lymphatic， but also metastasis V moved in adipose tissues. Broken of PSDM during traditional D2 dissection， cancer cells will leak out from the mesentery envelop to the serous cavity and it is the reason of local recurrence and implantation. Followed these new anatomic， pathological principles， a randomized control trial was conducted in GI surgery， Tongji Hospital at Wuhan， China. Although the final outcome of RCT is still on the review of submission or on the way， it was clear that laparoscopic gastrectomy （D2+CME） induced the improvement of surgical result and oncologic outcome simultaneously.

3. What is the membrane anatomy？ How to discover and apply the theory of membrane anatomy？ What clinical problems can membrane anatomy solve？

Anatomy is the setting in which life events occur. Membrane anatomy is one of the mesentery in broad sense and its beds. Mesentery in broad sense （MBS） is the fascia membrane （and serous membrane in the serous cavity） envelop the organs （or tissues） and their feeding structures， suspend and lead to posterior wall and space of the body. They have same structure， different forms and exist universally in our body. Cancer cells move in it， it is called metastasis V. Broken of MBS could induce cancer cells leak out from it to the field of surgery， which is the seeds of local regional recurrence. Only surgical MBS could be identified and managed by surgeons followed their forms and envelop-like membrane during operation， especially under laparoscopy. Followed the membrane anatomy map， CME in D2 field for gastric cancer （D2+CME） or one in D3 field for colon cancer （D3+CME） could be performed under laparoscopy. Increased evidence proved that the procedure based on the membrane anatomy could decrease surgical hazards and local regional recurrence in case of cancer limited in the envelop structure of MBS.

4. Compared with traditional laparoscopic operation， what are the advantages of radical surgery for gastrointestinal tumors guided by the theory of membrane anatomy？

Compared with traditional laparoscopic operation， such as radical gastrectomy， radical right hemicolectomy， the procedures of D2+CME for gastric cancer or D3+CME for colon cancer guided by the theory of membrane anatomy improved surgical results and oncologic outcome at same time， even the final results of RCT are on the way.

5. Could you briefly share the case of patient who has been successfully treated with the theory of membrane anatomy？

My team performed 8 cases of Live Surgery for GI surgeons in Rome， Milan， Berlin， Moscow in the past 5 years， and hundreds Live Surgery in China.

6. Regarding the new Journal of Trends in Oncology， could you please give any suggestions for the rapid development of the journal.

PubMed and SCI record is necessary for an international journal， at least in my opinion. New horizon report in the field is another key point.