Pathological Investigation of Grasping-related Mesenteric Injury During Laparoscopic Colorectal Cancer Resection.

BACKGROUND/AIM: Grasping the mesentery is a common maneuver during laparoscopic colorectal cancer resection. This study aimed to clarify pathologically the extent of mesenteric injury caused by grasping maneuvers during laparoscopic colectomy and to evaluate their safety.

PATIENTS AND METHODS

The study enrolled 34 patients who underwent laparoscopic colectomy and lymphadenectomy for sigmoid or rectosigmoid colon cancer from November 2021 to March 2022 at Saitama Medical University International Medical Center. Prospective histopathological analysis of mesenteric tissues and retrospective analysis of clinicopathological data were performed. Mesenteric tissues and lymph nodes along the sigmoid and superior rectal arteries were removed from surgical specimens and fixed in formalin for histopathological evaluation. Clinical data were obtained from the patients and supplemented by information retrieved from their medical records.

RESULTS

Injury was observed in lymph nodes and vessels removed during laparoscopic surgery with grasping maneuvers in >90% of the cases. There was one case of direct injury to a metastatic lymph node, with tumor cells found as venous tumor thrombosis in the main drainage vein and as tumor cells with lymphatic tissue in the drainage vein on the central side of the lymph node.

CONCLUSION

Mesenteric injury due to grasping was highly prevalent during laparoscopic colorectal cancer resection. In one case, tumor cells were identified within the vasculature in association with direct trauma to a metastatic lymph node, raising concerns about the potential for distant metastasis. These findings underscore the urgent need to develop safer alternatives to mesenteric grasping in laparoscopic colorectal surgery.