복막강 / 후복막강 (Peritoneal / Retroperitoneal cavity)

정확한 병기 설정을 위하여 복막에 대해 정확히 이해하는 것은 중요하다. 특히, 대장암과 직장암에서 seroalized area invasion(visceral peritoneum: T4a)와 non-serosalized area invasion(pericolorectal tissue / adventitia: T3)를 구분할 수 있어야 한다. Intraperitoneal organ과 retroperitoneal organ의 구분은 colorectal specimen을 cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum(upper, middle, lower)으로 구분할 수 있게 한다.

 

Peritoneum (복막) = mesothelium(중피) + conective tissue (결합조직)

Visceral peritoneum (내장쪽 복막) : intraperitoneal space, serosa
Parietal peritoneum (벽쪽 복막) : abdominopelvic wall
Mesentery (장간막) : middle, double membrane, vessels/nerves

 

Peritoneal cavity  

Greater sac
Lesser sac (communicate through epiploic foramen of Winslow)

 

Intraperitoneal organs

Stomach
Appendix
Liver
Transverse colon
Duodenum (1st part only)
Small intestines (jejunum and ileum)
Pancreas (only the tail)
Rectum (only upper 3rd)
Spleen
Sigmoid colon

 

Retroperitoneal organs

Suprarenal glands (Adrenal glands)
Aorta / Inferior venacava (IVC)
Duodenum (2nd~4th parts)
Pancreas (head, neck and body)
Ureters
Colon (ascending and descending) - Most surgeons consider these as intraperitoneal
Kidneys
Esophagus
Rectum (lower 2/3)

 
Primary retroperitoneal structures:

• Kidney
• Adrenal glands
• Ureters
• Aorta
• Inferior venacava(IVC)
• Rectum (lower 2/3)

Secondary retroperitoneal structures:

• Duodenum (2nd~4th parts)
• Pancreas (head, neck and body)
• Colon (ascending and descending)