Kataoka Atsuko, Kawasaki Tomonori, Kaira Kyoichi, Hirano Yasumitsu
Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Saitama, Japan;
Department of Pathology, Saitama Medical University International Medical Center, Saitama, Japan.
Anticancer Res. 2025 Jun;45(6):2493-2499. doi: 10.21873/anticanres.17620.
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.
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.
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.
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.
背景/目的：在腹腔镜结直肠癌切除术中，抓取肠系膜是一种常见操作。本研究旨在通过病理学明确腹腔镜结肠切除术中抓取操作所致肠系膜损伤的程度，并评估其安全性。
本研究纳入了2021年11月至2022年3月在埼玉医科大学国际医疗中心接受腹腔镜结肠切除术及乙状结肠或直肠乙状结肠交界处癌淋巴结清扫术的34例患者。对肠系膜组织进行前瞻性组织病理学分析，并对临床病理数据进行回顾性分析。从手术标本中取出沿乙状结肠和直肠上动脉的肠系膜组织及淋巴结，固定于福尔马林中进行组织病理学评估。从患者处获取临床数据，并从其病历中补充相关信息。
在超过90%的病例中，观察到在腹腔镜手术中采用抓取操作时切除的淋巴结和血管存在损伤。有1例转移性淋巴结直接损伤，在主要引流静脉中发现肿瘤细胞形成静脉瘤栓，在淋巴结中央侧的引流静脉中发现肿瘤细胞伴淋巴组织。
在腹腔镜结直肠癌切除术中，因抓取导致的肠系膜损伤非常普遍。在1例病例中，与转移性淋巴结直接创伤相关的脉管系统内发现了肿瘤细胞，这引发了对远处转移可能性的担忧。这些发现强调了在腹腔镜结直肠手术中迫切需要开发更安全的肠系膜抓取替代方法。
